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Westminster Hall

Volume 477: debated on Wednesday 11 June 2008

Westminster Hall

Wednesday 11 June 2008

[Dr. William McCrea in the Chair]

Specialist Trauma Response Teams

Motion made, and Question proposed, That the sitting be now adjourned.—[Mr. Roy.]

Even after 11 years, one of the joys of this job is that, every now and then, I come across an issue about which I know nothing. Somebody comes into my surgery, gives me a briefing and I go away thinking, “That’s extraordinary. I had no idea that was going on.” Specialist care for seriously injured people is such a subject.

A few months ago, a couple of my constituents—Phil Hyde and Ewan McMorris—briefed me about the work that they did. They said that the subject that they wanted to discuss was pre-hospital care, and I assumed that they would talk about rehabilitation, drugs, therapy or something that would prevent people from going into hospital. However, as the conversation developed, it became clear that they are providing an enormous specialist service, particularly in Hampshire. This morning, I shall go through some of the facts and figures about the service that they provide and consider how the Government can do more to support such work.

In essence, the role of those people is best described as taking the skills of an accident and emergency department out to serious accidents and injuries—most typically, a road traffic incident. The service they provide is different from that of the ambulance service, paramedics, and first responders, who are now quite commonplace and whom many of us will have in our constituencies. The philosophy behind immediate care is the prevention of the deterioration of a patient in those first critical minutes between the time of an accident and before they are taken to the A and E department.

I had assumed that such a critical service would be part of the NHS, but it is not. I was surprised to discover that the service is provided by volunteers, charities and a couple of organisations that work closely in the field. The British Association for Immediate Care—BASICS—and the Mid-Anglia General Practitioner Accident Service, which is an emergency medical charity, are the major players in the service. My amazement at the service they provide, coupled with my astonishment that it was not centrally funded, meant that I decided to probe the matter and do a bit more work on the subject.

I am delighted that my hon. Friend the Member for Romsey (Sandra Gidley) is here because I know that she has met the individuals concerned and has taken up some of the issues on their behalf. In Hampshire, we are lucky to have the service that they provide. On average, they attend an incident between two and eight times a day. In the Hampshire area, there were 1,200 requests a year for basic doctors and, through the work the charity does and the volunteers that it has, it is able to attend 750 of those calls. There is a big demand, but the worrying statistic is that although it is good that we have volunteers, they are not able to meet all the calls made on their watch.

The work involved often relates to traffic incidents, and we know that, on average, some 3,460 traffic fatalities take place each year. We also know that trauma is one of the big causes of death in this country. The latest figures suggest that trauma remains the fourth leading cause of death in western countries, including this country. Clearly, much work needs to be done to try to reduce the number of deaths. For each trauma death that takes place there are two survivors, who often end up with a serious and permanent disability. Anything that we can do to reduce the disabilities and injuries from which such people suffer will have a big impact on their lives.

The model that we have in this country differs from the rest of Europe. For example, Germany takes a different approach to trauma care. There is a nationwide network of helicopters and road vehicles that can, in 95 per cent. of cases, get a skilled doctor to the scene of an incident within 15 minutes. We even trail behind America in relation to trauma care. The UK mortality rate for severely injured trauma patients who are alive when they reach hospital is a staggering 40 per cent. higher than that of the US.

We know that the level of trauma-related deaths is high in this country, and that other European countries and America are able to tackle the problem better. We also know that, despite the various forms of support provided by ambulances, paramedics and first responders, there is still a desperate need to have skilled consultants and doctors who are able to get out to the incident. In Hampshire, although demand for the service is high, it is funded by charities and good will.

Why is it so important to have specialists as part of the service, and what do they do that is different from first responders and paramedics? First responders would be the first to acknowledge that they are not fully medically trained and can in no way replicate the work of a specialist doctor in A and E. It is also the case that, despite the wonderful work that paramedics do, their degree course lasts just three years. Let us compare that with the training required to be a consultant. Typically, a consultant in A and E would get five to six years at medical school and then a structured 12-year training programme before becoming a consultant. That is the level of skill and knowledge required to treat the most severe incidents of trauma.

The particular specialist skill needed relates to the airways and breathing of patients who have had severe head injuries. Paramedics are not trained to clear the airway or use the necessary drugs and anaesthetics in the treatment of those injuries. In many cases, paramedics are legally prevented from doing so because they are unable to administer the drugs. All the evidence that I have seen suggests that the critical area that an individual needs to have treated at an incident is around the airway, and that anaesthetics and drugs need to be issued. None of those who currently attend incidents are able to treat that specialist injury. However, the specialist consultants from A and E departments can do so, and we are trying to ensure that more of them can carry out that particular work, often at the roadside.

A fair bit of work and research has been done on the subject. The most recent report was in 2007 when the National Confidential Enquiry into Patient Outcome and Death produced a report entitled, “Trauma: Who Cares?” The report takes a general look at how we handle a situation when there is an accident leading to trauma, and considers what happens in the first few moments after an incident. It states:

“The current structure of prehospital management is insufficient to meet the needs of the severely injured patient. There is a high incidence of failed intubation and a high incidence of patients arriving at hospital with a partially or completely obstructed airway. Change is urgently required to provide a system that reliably provides a clear airway with good oxygenation and control of ventilation.”

The report highlights the particular specialist skills needed at the scene of an accident. In the study, NCEPOD produced an analysis stating that 60 per cent. of patients whom it looked at received a standard of care that was less than good practice. It also states:

“Many of these clinical issues were related to the lack of seniority and experience of the staff involved in the immediate management of these patients.”

Again, the critical issue is seniority and people having the skills to tackle breathing and airway problems.

It is not just NCEPOD that has looked at the issue; the Royal College of Surgeons has also raised concerns in a number of studies. Initially, in 2000, the college called for defined trauma systems comprised of major trauma centres to be established in each region. It describes—in its words—

“the lack of political will”

to tackle the issue. It revisited the subject in 2006 and reported little progress or improvement. Its analysis is that the likelihood of dying from injuries has remained static since 1994 despite great improvements in trauma care, training and education. There are not many areas of the health service in which things have remained static since 1994, certainly under the Labour Government—I welcome some of their investments. With many of the indicators, one can see that the advancement of knowledge has been matched by improved outcomes, but this area has remained static since 1994.

Last night, the RCS e-mailed me with a further update on the issue, in which it raised more concerns. It welcomes the fact that volunteers and charities are putting provisions in place throughout the country, but says that coverage is patchy. It describes a postcode lottery and says that there is great inequality in access to and provision of pre-hospital critical care. As a consequence, there are preventable pre-hospital and early-hospital deaths that could have been averted had there been access to appropriate services.

It is troubling that the RCS is saying that we could save lives if we had that kind of system in place across the country. In its note, it estimated that a national system of 24-hour access to specialist physicians who could go out to incidents would probably require an additional 200 specialist practitioners, who would need to be funded. I do not have more accurate figures than that estimate, but if those are the kind of figures involved and if it would have a dramatic impact by cutting the number of deaths, as the RCS says and as other evidence suggests, it would be a small price to pay.

Air ambulances are critical to the ability to save lives after a traumatic incident; however, there are contradictions. I understand that, in London, daytime provision of the air ambulance is centrally funded, but that the evening service switches to charitable funding. There was a debate on air ambulances in Westminster Hall in February for which the RCS did a lot of work. It said how important the role of air ambulances is, but it was extremely concerned that it is left to charitable trusts and individual primary care trusts to fund them. The RCS argues strongly that it is excellent value for money to have an air ambulance.

Another issue that the RCS has raised is the provision of helipads close to accident and emergency departments. There are many examples—including one in Southampton, close to the constituency of my hon. Friend the Member for Romsey—of the ridiculous situation in which the air ambulance is able to get to the scene of a trauma quickly, but is then unable to land near the hospital and has to land a six or seven-minute ambulance journey away from it, so an ambulance has to go to the air ambulance and bring the patient to the hospital. After the air ambulance has provided such a quality service, having got to the scene quickly, it is enormously frustrating to the professionals involved that an additional journey is needed at the end.

I am sorry to interrupt the hon. Gentleman’s flow, because he is being extremely eloquent in showing how much he cares about this important issue. I congratulate him on securing the debate. Is he aware that when the new Queen’s hospital opened in east London, with a specialist neurosurgical centre, the local council placed restrictions on the landing of air ambulances delivering patients at certain times of day? That was an unhelpful interpretation of the balance of inconvenience by the various players in that decision.

I was not aware of that, and I find it extraordinary that a local council representing potential patients would take that decision. Certainly, my conversations with the chief executive of Southampton hospital suggest that he would not have that kind of difficulty with Southampton city council. He thinks that the population would strongly welcome hearing the sound of a helicopter and would find it reassuring.

I have written to Mark Hackett, the chief executive of Southampton University Hospitals NHS Trust. He is keen on having a helipad, but pointed out that funding for it is not available and that there would have to be some sort of public appeal to raise money for it. Given that we are talking about something that could save lives, does my hon. Friend think it right that local members of the public should have to dip into their pockets yet again?

I had a similar conversation with Mark Hackett, who told me that the cost, on its figures, would be about £1 million. He hoped that it might be possible to reduce that cost by putting a helipad on top of a building and incorporating that into ongoing rebuilding at the hospital site. I am no engineer or scientist, but one would think that reasonably easy to achieve. It is breathtaking that such a service should have to depend on charity in today’s modern world, particularly as it would cover a region with a radius of about 150 to 200 miles. It would provide a quality service covering the Isle of Man and going through to Dorset, which is an enormous area. One would think, therefore, that it would attract public funding.

It is not for me to tell any of the three political parties what would be an eye-catching issue at the next general election—I am not standing at the next election, so I do not mind too much—but I should think that any party that commits to introducing 10 helipads across the country to ensure that individuals can get straight into an accident and emergency department would have a simple, popular message with a particularly low cost. It is extraordinarily odd that we leave the funding of air ambulances and their work to the good will of volunteers and charities. I hope that the Minister will comment on that.

Four, five, six or seven—anyone is entitled to put forward the policy, but it would be wonderful if the Minister prevented other parties from doing so by announcing something today.

Let me address what is the best way forward with funding. I totally understand that there are demands on Government funding and I am reluctant to say to a Minister, “Come on, cough up,” because so many areas have to be funded. I know from parliamentary questions on this issue that the Minister and his colleagues have said, “Look, fantastic work is being done and we totally recognise that this is providing a real benefit to the health service, but it is for local PCTs to decide whether to fund it.” That is a cop-out, because we know the pressures that local PCTs are under. Is it right to say that we are going to leave it to the lottery of whether a PCT is able to support such work? People throughout the country—certainly my constituents and, I am sure, those of other hon. Members—want the reassurance that they will get the best-quality support if they are involved in a major trauma anywhere in the country, but that is currently left to good will and chance.

I hope that the Government will consider this issue further and do more work on it. I am encouraged by some of the statements that have come from Ministers so far, who have at least acknowledged that there is more work to do. Lord Darzi said:

“We have taken on board the recommendations of NCEPOD, not necessarily just regarding pre-hospital admission. We also need to have, and define for the first time, dedicated regional trauma centres. It is the one area where there is clear evidence that centralisation of services, with adequate competencies at the site of receiving hospitals, will significantly impact on the quality of care.”—[Official Report, House of Lords, 7 January 2008; Vol. 697, c. 630.]

I could not agree more and I hope that the Minister present agrees with his colleague. With that in mind, I ask him to confirm whether he plans to meet the authors of the NCEPOD report. In a written answer in April, he told me that officials were arranging for a further meeting to take place, so I hope that progress has been made with people’s diaries; indeed, the meeting may have taken place.

According to a written answer last year from one of the Minister’s colleagues, who has moved on to the Home Office, the Government acknowledged the work of the RCS in this area and were hoping to do more work and have meetings with it. It would be helpful to know whether that work has been done and whether the Government have made an assessment of the RCS reports on trauma.

I was amazed to discover that the whole area of specialist trauma response did not exist as part of the NHS. Having met the surgeons involved, I am convinced that, despite the good work of paramedics, the ambulance service and first responders, there is a very big gap—the ability of high-quality experts with high levels of training to reach the scene of an incident quickly and provide the drugs, skills and airway support that definitely could, based on studies done so far, save lives. Linked to that is the question of a decent, funded air ambulance service. We need to put the two elements together. If the Government were prepared to move on this and to put some funding in—not necessarily fund the whole project, but put in some match funding—we could make a significant difference to the number of people who are dying unnecessarily in traffic accidents and as a result of other serious injuries.

I just want to add a footnote to the excellent speech made by the hon. Member for Winchester (Mr. Oaten)—my parliamentary neighbour. As you may have seen, Dr. McCrea, a high percentage of Hampshire MPs are present.

I pay tribute to the work of Dr. Phil Hyde and the team in Hampshire for raising the profile of this issue as well as providing the help that the hon. Gentleman described. Like him, I was not aware of the service until my constituent, Dr. Louisa Chan, who lives in Whitchurch, wrote to me. She is one of 19 volunteer doctors and one consultant nurse in the county who act as volunteers working for BASICS—in her case, after doing 56 hours of full-time work for the NHS. She uses her own car with a blue light in responding to call-outs. As the hon. Gentleman said, at the moment, the team can respond to about half the number of call-outs. Of course, they are not called out every time that an ambulance is summoned; they are called out only to the more serious emergencies where their skills could make the difference between life and death. I pay tribute to those volunteers. They were very active following the train crash at Ufton Nervet a few years ago; they were on the scene very quickly.

I want to put this issue in a slightly broader context. The hon. Gentleman touched on the fact that one could argue that this is not the only service that ought to be mainstream NHS but is slightly at arm’s length from it. I suppose that the best example is the hospice movement, which one could argue ought to be mainstream NHS. It started off in this country totally independent, run by voluntary organisations, but it is now moving more towards the mainstream NHS; the hospice movement is receiving more support. In Hampshire, we have fantastic hospices: Naomi House, in the hon. Gentleman’s constituency, and the Countess of Brecknock hospice and St. Michael’s hospice in my own. That is an example of a service that started outside the NHS but is gradually being absorbed into the bloodstream, if I can put it in that way.

The other example, which the hon. Gentleman touched on, is the air ambulance, and it is quite a good parallel with the BASICS service. Until last year, the only local air ambulance service was the one in Thames valley, which I do not think has ever received a penny of public money. We now have our own in Hampshire—the Hampshire and Isle of Wight air ambulance—which, again, I think receives no public money at all. One could say that that is slightly odd. The police have helicopters. No one has ever argued that the police should have a whip-round for police helicopters. They are an integral part of the police service, but specialist trauma response is another emergency service and, for some reason, its helicopters have to be funded in a totally different way. It is not immediately clear why that should be so.

Then we have BASICS, the service to which the hon. Gentleman referred. One could argue that the case for absorption of that service is stronger. With hospices and helicopters, there is something visible for which people can raise money, but for this service, there is nothing visible at all. It is an unseen part of the service. Therefore, one could argue that the case for total absorption and integration is stronger. It is very difficult to say that it is an acceptable risk for patients to rely on off-duty volunteers, possibly to save their lives.

I am sorry to intervene so soon. I am grateful to the right hon. Gentleman for his speech on this issue. He reminds me about the ridiculous situation in which some consultants are on duty, operating and working in the accident and emergency department, waiting for emergencies to come in, and their pager goes off, asking them suddenly to switch to become a volunteer and go out. They cannot do so, because they are working in the hospital, and they have to wait for the patient to come in, knowing that if they had been able to go out as a volunteer, they perhaps could have helped to save a life. What better example is there of the fact that the service should be integrated?

There probably is no better example, and the hon. Gentleman makes the point very well.

Last year, the Hampshire service received the Queen’s award for voluntary service. I commend it for that. The hon. Gentleman referred to the National Confidential Enquiry into Patient Outcome and Death, which highlighted the inadequacy of out-of-hospital care. It said:

“The current structure of pre-hospital management is insufficient to meet the needs of the severely injured patient.”

I agree. It seems to me that the objective should be to integrate the service that the hon. Gentleman has described into a properly funded pre-hospital service, with doctors and paramedics working together as a team.

The debate calls for a ministerial response, and I am delighted to see the Minister in his place. He can say one of a number of things. First, he could say, “These are wonderful people. I applaud what they do, and I would like to provide this life-saving service as part of the mainstream NHS, but the resources are not there, so we will carry on as we are.” Or he could say, “The case has been made. We recognise that, in most other countries, this service is an integral part of a national health service. We accept the case. We will make this a priority, and either move ahead with earmarked additional resources or ask people to do it within existing budgets.” Or I suppose that he could say that he wants to reach the same destination by another route; he wants progressively to upskill the paramedics, reduce the call-out times, put better equipment in ambulances and implement similar solutions. I am not sure whether that would achieve the same objective. The paramedics are fine. For the average call-out, they have the necessary skills, but as the hon. Gentleman said, they simply are not trained to the level of doctors.

The Minister might like to respond to this point. The new GP contract contains a provision for a national enhanced service for immediate care, but as I understand it, almost no primary care trusts have commissioned one, so there is a provision, but it is not being activated. This is what we need to know from the Minister. What is the philosophy? What is the policy? Should the service be a mainstream part of the NHS? If so, how will we get there, and as the hon. Member for Winchester said, who will pay for it?

I have a final point about the landing site in our area. The paradox at the moment is that, when someone called out under BASICS gets to the scene, there is almost always an ambulance there as well. If an air ambulance is summoned and takes the patient to Southampton, they then have to go by ambulance to the hospital, as the hon. Gentleman explained. The same ambulance that attended the initial incident then goes to the helipad, so there is no gain in time at all from using the helicopter. Given that paradoxical situation, there is an urgent need to make some progress with a more accessible helipad for patients who are taken to Southampton hospital. I am sure that the Minister will respond as sympathetically as he can, and I commend the hon. Member for Winchester again for raising the profile of this important but neglected subject.

First, I must declare an interest: my son is a consultant neurosurgeon.

I congratulate the hon. Member for Winchester (Mr. Oaten) on securing a debate on this important issue. He raised some interesting points. We are fortunate today to have an excellent Front-Bench team, and I am delighted to see the Minister in his place, as I know him to be a caring man. The Government have invested much more in health over the past decade, and I congratulate them on that. However, our constituents do not see a proportionate improvement in health outcomes. We are debating an area in which a little extra spending might give results that people would welcome; I ask the Minister to consider that point.

The hon. Member for Winchester mentioned the different approaches taken by various countries, and we clearly need to review the way in which we provide immediate, on-the-spot care for trauma patients. The hon. Gentleman focused on the first few moments of care. I want to extend that to the first few hours. He mentioned the importance of breathing, clearing airways and similar issues, but I want to focus on head injuries.

Research and experience indicate that there should be no more than four hours between injury and operation if there are expanding mass lesions, such as extradural or acute subdural haematomas. Only 20 per cent. of patients with severe head injuries are treated within those four hours. The problem is not the one hour leading to the CT scan. That is usually met; the response is pretty good. The problem is largely with the inter-hospital transfer—from the hospital that first receives the patient to the specialist hospital capable of dealing with severe head injuries. That is where the problem lies.

The ambulance service and the hospital management team probably consider that, because the patient is already in hospital and in a secure and safe environment, the need to move the patient to another specialist hospital within the four hours is not so important—the priority is lost or diminished. That perception is one reason why the four-hour limit is not met in 80 per cent. of cases. That should be a top priority. If that limit can be met, the outcome for the patient is so much better. However, when it is not met, the outcome becomes worse as time goes by. Many patients die who could otherwise have been saved; and others suffer severe and permanent disabilities who otherwise would not suffer them. Although it is important to treat a collapsed lung, once the patient is in hospital it will not kill them. However, a head injury can kill or cause permanent damage. We need to focus on that specific but small issue. I am sure that the Minister is listening carefully.

A good development that the Government are pursuing is the specialist trauma centre. Patients suffering multiple traumas are taken there in the first instance rather than to a general hospital. That is extremely helpful, because it does away with the inter-hospital transfer. The four-hour limit is more likely be met, and the outcome for patients with severe head injuries and other traumas will therefore be much better. I welcome and support the Government’s move on specialist trauma centres.

The hon. Member for Winchester spoke of funding, and I shall follow him. One reason why the UK Independence party wants to repatriate the £15 billion cost of our membership of the EU is to invest more in specialist services, such as immediate trauma care and health care generally. That is another sound UKIP policy.

I congratulate my hon. Friend the Member for Winchester (Mr. Oaten) on securing this debate. I have been trying to secure a debate on the subject.

My hon. Friend mentioned Dr. Phil Hyde. Dr. Hyde has also spoken to me. He is clearly passionate about the subject, and there is a real issue over patient safety. I was taken aback and horrified by what I heard in my conversation with him. Before that meeting, despite shadowing ambulance teams on a number of occasions, I had no inkling that, if I were to be seriously injured in a road traffic accident, my prognosis would be severely affected by whether a voluntary doctor happened to be available. That is scandalous.

The 2007 report by the National Confidential Enquiry into Patient Outcome and Death entitled “Trauma: Who Cares?” has been mentioned. It concluded that the current structure of pre-hospital management is insufficient to meet the needs of the severely injured patient. It said that there is currently a high incidence of failed intubation and of people arriving at hospital with a partially or completely obstructed airway. It went on to say:

“Change is urgently required to provide a system that reliably provides a clear airway with good oxygenation and control of ventilation. This may be through the provision of personnel with the ability to provide anaesthesia and intubation in the prehospital phase or the use of alternative airway devices.”

That was highlighted as something that needed to be addressed by ambulance trusts, but it is clearly not happening.

Research shows that patients who die from severe injuries often do so within the first hour after the accident. In the United Kingdom, that hour has usually passed by the time the patient reaches hospital. However, sending a BASICS doctor to the scene of an accident is the nearest one can get to sending the hospital to the patient. BASICS doctors will often perform a specialist procedure, known as rapid sequence intubation, to help to stabilise the patient. Once the patient is stabilised, the doctor will be able to judge which is the best hospital for the patient.

The hon. Member for Castle Point (Bob Spink) mentioned the specialist trauma centres that are being introduced and said that the outcome for patients will be much improved if they can be stabilised and taken to an appropriate specialist unit. If there is no doctor on the scene, such patients suffer a double whammy. They will not have been stabilised at the scene, so it is often decided to take them to hospital quickly, but the nearest hospital may not be the most appropriate. We all know that some hospitals excel at certain aspects and some at others. Many patients are therefore not given the greatest chance of recovery.

As someone who has probably overdosed on episodes of “Casualty”, I was surprised to learn that accident and emergency consultants are not generally in the business of donning hard hats and bright protective clothing and going to the scene of accidents. I asked, “Isn’t that what happens?” I was told that they could not leave the casualty department, although some are BASICS doctors in their spare time. Not everyone who works in the casualty department is suited to working on the road.

In the casualty department, there is plenty of light, the equipment is where it is needed and there is space to operate on the patient. At the scene of a car crash, one has to work with the noise of the machinery and the fire engines in a confined space; it is a completely different environment. I understand that not everyone can operate easily under those conditions. Those who do so are a special breed.

Most of the doctors who provide the BASICS service are fully employed in the NHS—sometimes in A and E, as I said, but often in other disciplines, such as intensive care or surgery. BASICS doctors are particularly valuable in providing complex airway management procedures and stabilising patients in a critical condition.

BASICS doctors work closely with the ambulance service when a multi-agency response is required locally or when additional skills and qualifications are needed. They are usually called when a paramedic decides that he or she does not have the training to deal with an incident. The paramedic who arrives at the scene will often call the BASICS doctor, although in the case of a fatal crash, the control centre will sometimes call them out.

An industrial accident involving a worker who has become trapped in machinery is a good example of what happens. The ambulance service would work alongside the fire service to co-ordinate the rescue. BASICS could supplement the skill set available at the scene by providing a medical doctor with the necessary extra skills. If necessary, the doctor may use a surgical procedure to extricate the patient, although that is obviously a last resort.

I know Hampshire best, and it is where I have the best figures from, so I will use it as an example. As the right hon. Member for North-West Hampshire (Sir George Young) said, the county has 19 volunteer doctors and one consultant nurse for a population of more than 1 million. Those BASICS staff work on their own time and carry a pager that is activated by the ambulance control in Winchester. Once paged, they must travel to the scene of the accident in their own cars, using blue lights and sirens. BASICS staff must provide not only their own transport, but all their own equipment. It can cost up to £25,000 fully to equip one of those doctors. Frequently, some of the money comes from the doctors’ own pockets, although staff do not really have much time for fundraising between doing their day job in the NHS and volunteering in their spare time.

Let me give a few statistics. In Hampshire, BASICS doctors are usually called out between two and eight times a day. There were about 1,200 calls last year, and BASICS doctors managed to attend 750 of them. We can only hazard a guess about what difference they might have made in the 450 cases in which no such response was possible.

Perhaps I can give a snapshot of what the BASICS staff do. In January, they responded to 58 calls, although I do not know how many they were unable to respond to. Two thirds of the calls that they responded to involved motor vehicle collisions. The others involved falls, burns and machinery accidents. In 16 cases, the doctor was required to give anaesthetic drugs. In 10 cases, they provided advanced wound management and life-saving minor surgery, as well as injecting drugs into the aorta. I mentioned the importance of admitting patients to the most appropriate hospital, and 26 of the 58 patients had their destination altered, because of the knowledge and expertise of the BASICS doctors.

Things vary throughout the country. In Sunderland, which has one of the best survival rates, the death rate for people coming into the unit is 2.9 per cent.—half the national average. Bosses from City Hospitals Sunderland NHS Foundation Trust say that that is due to high investment in staff and facilities. Interestingly, the trust has also introduced a new trauma response team, and the figures speak for themselves.

It might also be worth mentioning London, which seems to have more advanced provision than many areas of the country. Specialist trauma teams are funded by, and travel with, the London air ambulance service. As my hon. Friend the Member for Winchester said, however, the air ambulance stops flying at night for some reason, and some of the provision then becomes voluntary. I am told that there are also only 15 BASICS doctors in London, covering a population of 8 million people. The moral of the story appears to be that, if someone is going to be involved in a serious accident, they should make sure that it happens in London during the day, so that they have the best chance of receiving specialist care.

Clearly, there are many political priorities, and I can understand why there is not a huge patient lobby banging on the door to raise this issue. The Government could therefore quietly ignore the problem or dismiss it with the old chestnut that, “This is nothing to do with us. We’re trying to get these decisions taken locally.” However, we need to take a more strategic approach to determining which specialist services are provided and where. People do not have accidents along primary care trust boundaries, and the issue is a real example of a postcode lottery—I hate using that term, but I have never seen a better example of one.

The fact remains that investment in this volunteer service can save money in the long term, because patients will have better outcomes and be less likely to need intensive post-trauma support packages or access to other benefits. The Government presumably have an interest in keeping their citizens safe and well.

I want now to summarise the national inquiry. The inquiry noted that the standard of care received by 60 per cent. of patients was less than what was judged to be good practice, and deficiencies were identified in organisational and clinical aspects of care. Difficulties were highlighted in identifying patients with an injury severity score of more than 16. Again, if such things are done properly, it will optimise the use of precious resources. Problems were identified not only with immediate pre-hospital care, but with trauma team responses generally and with the seniority of the staff involved once someone actually got into hospital. People were frequently not seen by a consultant within the first 12 hours, even though they were probably among the most injured patients in the country. Problems were also identified with immediate in-hospital care and the provision of suitably qualified staff at all times of day and night.

The report made a number of recommendations. It identified the need for designated trauma centres, and I acknowledge that we have had some movement on that. It also asked for a verification process to be developed to guarantee the quality of care. The report referred to the pre-hospital management of airways, which I have mentioned. It stated that a trauma team should be available 24 hours a day, seven days a week. It also noted that a consultant should be the team leader for the management of severely injured patients. The report also made recommendations about the nature of CT scanning once people were in hospital.

As has been highlighted, this is not a new problem. One of the most depressing things that I read was that the Royal College of Surgeons had looked at this issue in 1988 and 2006 and said that there had been no progress. It noted:

“most of the improvement in the outcome of these patients occurred prior to 1995, with no further significant change occurring between 1994 and 2000.”

That is quite a damning indictment of what we are doing—or not doing.

Also pertinent to the debate is the NHS emergency planning guidance, which contains principles for effective emergency health planning. The chief executive of each NHS organisation is responsible for ensuring that it has a major incident plan in place. Given what we have heard about trauma response, it is somewhat ironic that that major incident response could apparently also hinge on the availability of volunteer doctors.

The situation that I have outlined is not sustainable in the long term. I hope that the Minister is sufficiently persuaded by what he has heard today to commit to improving services. Put simply, if any of us or our constituents ever need trauma care, we surely deserve the best.

Let me declare an interest at the outset as a trustee of the new Essex and Herts Air Ambulance Trust and a patron of St. Francis hospice in my constituency. I will say a little about hospices later.

I congratulate the hon. Member for Winchester (Mr. Oaten) on his passionate and articulate speech on this important subject. He raised so many issues in his short contribution that it will be difficult to address them all, but I hope that the Minister will deal with many of them and perhaps some of those raised by other hon. Members.

My right hon. Friend the Member for North-West Hampshire (Sir George Young) spoke about the hospice movement. There is an obvious link between that movement and the sort of voluntary medical care that we have been describing. My right hon. Friend alluded to the fact that the hospice movement is being drawn closer to the NHS, because of their funding streams; but one of the biggest concerns of my local hospice is that the tail is starting to wag the dog. The NHS is starting to fund it and tell it how to provide care, which is completely against the way that the hospice movement was set up. That relates to some of my concerns about the topic that we are debating.

I, like many other hon. Members, have been contacted by Dr. Phil Hyde of BASICS. I am due to meet him in the next few weeks. I have also been contacted by other groups, such as the Sussex and Surrey immediate medical care scheme, and by Dr. Alan Jones at Mid-Anglia General Practitioner Accident Service—another excellent voluntary organisation. One of the most telling things that the hon. Member for Winchester mentioned was the figure of 750 responses to 1,200 requests. That is a fantastic response for a voluntary organisation; but as a former member of the emergency services who has attended road traffic accidents while we waited for response units, I know that it is a frightening experience for the patient and the other emergency services when they do not know who is coming and whether there will be a response. As the hon. Member for Romsey (Sandra Gidley) said, that is not new.

I have been out of the fire service for some 17 years, but in the 11 years that I was in it, I never once trained alongside an ambulance paramedic crew. We do not train together. What goes on out there is frightening. When people arrive at an incident, the training clicks in, but very often it is individual training. I was out recently with a crew from the London ambulance service, and I asked them when they last trained with other emergency services—the police or particularly the fire brigade, with whom they would go to RTAs. The gentleman I spoke to had served 20 years, and he had not trained in that way. I asked my own local fire crew, green watch at Hemel fire station, which is a joint station with the ambulance trust, “When was the last time you trained with ambulance paramedics?” and was told, “We don’t sir; we ask but it does not happen.” The pressure of time, particularly on the ambulance service and paramedics, is crucial.

An aspect that we need to examine, which has been alluded to in the debate, is best practice, if that is what we want to call it, and the lack of a defined system throughout the country. I, like the hon. Member for Romsey, do not like using the term “postcode lottery” for the pot luck situation in which where people live affects the emergency services that they may need to use, but I do not know a better way to describe it. People in one PCT are likely to get better care than people in others. I, too, have been to Sunderland and Newcastle, where they have a wonderful system, but I have also been to other parts of the country where things are much more difficult.

It is best to listen to the experts as well as to politicians. A recent report by the Royal College of Surgeons shows that a third of all deaths from trauma are avoidable. That is in the 21st century NHS, with £110 billion going into it, and the vast majority of those cases involve people under the age of 44. The largest cause of death of people under 44 in this country is trauma—road traffic accidents. Our lifestyles mean that those incidents will occur. So, surely, we should have a level playing field across the country for the care and expertise to be provided by the emergency services when they arrive.

I have also read reports that say that consultants are needed to lead trauma teams at as many incidents as possible. The problem is that, as many hon. Members know, we have a shortage of consultants, particularly accident and emergency consultants, and as those pressures mount, it is very difficult for any PCT or acute trust to decide to take a consultant out of A and E and send them to an incident. I should very much like to discuss during this debate how we could increase paramedics’ skills. I fully admit that in the past decade the skills of our paramedics, who serve us wonderfully well, have hugely increased.

I was a paramedic in Her Majesty’s armed forces many years ago. A paramedic means something completely different in the armed forces. I left the Army in 1982, with three years’ training as a paramedic for use on the streets of Northern Ireland, where we dealt with huge problems, with airways in particular. We were trained in tracheotomy. The most basic Army paramedic had done a tracheotomy course before being deployed with troops. When I left the armed forces and joined the Essex county fire and rescue service, I was asked to take a first aid course: I had three years’ paramedic training. I would love to say that things have changed and that we have better paramedical or even first aid skills in our emergency, particularly fire, services. In some parts of the country that is true, but mostly it is not.

Will the Minister think about the skills base of our armed forces? We learned this weekend that three of our brave Paras from the 2nd Battalion the Parachute Regiment, had died on active service in Afghanistan. However, many members of our armed forces who are injured on active service survive injuries that they would not have survived 10 or 20 years ago. Is it a consultant from accident and emergency who attends them in the field when they have been blown to smithereens or a consultant A and E surgeon who treats them when they have been shot while in the field? No. It is a paramedic: highly skilled paramedics who understand and can do the work there and then, at the incident, to keep someone alive long enough to enable the experts to get hold of them.

We have made enormous progress with the skills of paramedics and with air ambulances throughout the country, but that is sporadic, with respect to skills and qualifications. That is something that we can consider, because we need to think carefully about how money is spent in the NHS. As well as using the extra skills of the volunteers who have been mentioned—many of whom tell me, interestingly, that they have retired from the NHS and keep their hand in by using such skills—I should like to examine the skills base of our paramedics.

We have heard about the ambulance service this morning. It was a great honour for me to be asked to be a trustee of the new Herts air ambulance service—a completely charitable organisation, which was set up because Essex air ambulance was covering Hertfordshire as a charitable organisation. That is fundamentally wrong: the Essex air ambulance was in Hertfordshire, and was not giving cover to the people who had raised funds for it, so we worked together on the situation.

Alongside my hon. Friend the Member for Welwyn Hatfield (Grant Shapps), I sat in on some of the meetings with the PCT, ambulance trust and other bodies, and I could not believe how difficult it was to agree what sort of ambulance we should have. Should it have a paramedic on board, and who would pay for that? Should it have a consultant? Should it have a trauma team? Should it be just a lift helicopter, which goes straight to the incident and, once the patient has been stabilised, is up and away to the nearest major trauma unit?

I praise the Government for initiating major trauma units. The Minister knows that I am concerned about accident and emergency and acute services being penalised, because of money going elsewhere. A and E departments are closing, not least in my constituency. However, I could not believe the lack of willingness at the meetings that I attended to say, “This is a voluntary organisation, raising money to help local people, so let us sit down and help them, rather than come up with lots of reasons why what they propose should not happen.” I understand from other air ambulance trusts around the country that that is not new. The availability of ambulances is a completely ad hoc situation.

I was astonished by what the hon. Member for Winchester said about helipads. We had a short conversation about it before we came into the Chamber. To use another military example, it is possible to put a helipad down nigh on anywhere in an emergency, if necessary. Two people—one person—can lay a helipad and make sure that the windsock goes up, the helipad markers are down and there is a certain amount of space.

Frankly, it is ridiculous in the 21st century that someone who is so seriously injured that they need to be casevac’d by helicopter should be put back in an ambulance to be driven to the A and E department. I hope that the Minister will look into that and give assurances to the Chamber that, if it is taking place, it will be stopped. It cannot be what our constituents deserve. We must consider how our communities can work together better for our constituents—whether the voluntary sector, PCTs, which in some areas are under extreme financial pressure, or acute trusts, which are also under pressure financially and because they are trying to centralise services. With something so serious, Ministers must get away from saying, here in London, “This is nothing to do with us. It is a matter for PCTs and localisation.”

The other day, I asked a very simple parliamentary question about which services should be available at a hospital advertising an A and E department—not a minor injury unit, a surgery centre or a polyclinic. Driving around my town, like most of my constituents, one will see signs for the hospital with “A&E” written underneath. In response, I was told that it is matter for local PCTs. That should not be the case for a question as acute as which hospital someone is taken to when critically ill. There must be a set plan for what is available throughout the country when dealing with major trauma. In my case, I took my daughter to the A and E department at my local hospital, only to be told that it could not take her, because it does not do paediatrics and has no children’s facilities. Naturally, because she was very ill, it said that it would look after her as best it could and then move her to the Watford hospital.

The least that our constituents deserve is for the Government to set out centrally a basic template of what services should be available throughout England and Wales—I realise that such responsibility is devolved in Scotland—so that all of us, no matter where we live in the country, get the best possible provision that the NHS can provide.

I congratulate the hon. Member for Winchester (Mr. Oaten) on raising the important question of how the NHS deals with trauma, which is an issue of interest to many hon. Members. I also welcome the valuable work of all those who work within the British Association for Immediate Care, to whom I am sure that all hon. Members present are deeply grateful. I am also sure that all hon. Members share my desire to see NHS services deal effectively with severely injured patients, and to give them the support and treatment that they need. I agree that trauma care is a serious issue on which the NHS has not performed as well as it might have done in the past.

The issue is about not only how best the NHS can deal with seriously injured patients, but who is best placed to make detailed decisions on staffing and the organisation of services. These debates often tease out the tension between the desire to devolve more powers and decision making to local and regional levels, which all political parties represented here are signed up to, and the need to explore whether there should be a stronger national framework—again, that has been well illustrated in this debate.

The Government believe that, as the hon. Member for Hemel Hempstead (Mike Penning) just suggested, we should give strategic direction—a national framework, if hon. Members like—to public services. However, in the end, it is for local and regional health bodies to determine the best organisational arrangements to ensure that the right people are in the right place at the right time to look after patients appropriately.

I agree that the basic infrastructure for deciding where people should be taken must be a matter for local authorities. However, the question of what type of care is available must be for central Government diktat, otherwise we will continue the postcode lottery that affects the NHS today.

The idea that the decision on what is available, and where, should be for central Government diktat is very interesting coming from the hon. Gentleman, and I might bring it up in future debates, if he is suggesting that we are being too dirigiste. However, I shall elaborate on my arguments in a moment.

The hon. Member for Winchester has rightly pointed to last year’s report on trauma care from the National Confidential Enquiry into Patient Outcome and Death, which stated that every year between 3,000 and 4,000 severely injured people are admitted to hospital in the UK, so the majority of hospitals see fewer than one severely injured patient per week. The report found that hospitals that saw more patients had better outcomes, as they were more used to dealing with challenging cases. The NCEPOD report recommended the establishment of regional, specialist units and the development of protocols to ensure, for example, that ambulances take patients to the most suitable centre, bypassing others that are nearer, where it makes clinical sense. It also made recommendations on the care that should be available to patients before arrival at hospital. When it was published, the Government welcomed that report, and we will take forward its recommendations.

The NHS is already improving services provided by ambulance staff at the scene of such incidents and accidents. As the hon. Member for Hemel Hempstead has rightly pointed out, there is an interesting contrast between the improved performance of the military medical services, in the field abroad, where we have seen dramatic improvements in survival and recovery rates among armed service personnel after severe injury, which has not been replicated in civilian trauma treatment. We are very keen to learn the lessons from that. He was also absolutely right to stress the important role of paramedics, who, I am informed, already do a lot of work in unblocking windpipes, for example, which I think that he acknowledged. There could be an issue about the delivery of anaesthetics, which might require doctors being called in from elsewhere. However, we are certainly keen to learn as much as we can from the experience of the armed services, and I have already asked my officials to look into that.

I am sure that the Minister realises that many of those skilled military medics are actually NHS employees and members of the Territorial Army, who do a fantastic job for our armed forces when they deploy with their TA units.

Absolutely. However, it is also important, when we talk about the respective experiences of the armed forces and the civilian health service—this touches on a point that the hon. Gentleman has raised about rules and regulations for the use of helicopters—to acknowledge that different health and safety parameters can apply to armed forces and civilian services.

The Army point is interesting. I am not an expert, but my understanding is that NHS consultants who work in accident and emergency departments often work in Afghanistan or Iraq. Perhaps one of the reasons for the improvements relates to the lesson about BASICS. It may be not the trained paramedics, but the consultants working in the field who are making the difference.

We are drifting away from the subject of the debate into another important area. We are acutely aware of the benefits of the cross-fertilisation of experience between the NHS and the military health services. In fact, the Government recently published a paper asking all trusts to encourage their staff to join the TA and to gain experience in the field. The hon. Gentleman is right—the more experience that staff can gain, the better.

The other very important development under way is the next-stage review, under the auspices of my noble Friend, Lord Darzi, who published his report on the future of health services in London about a year ago. I am sure that hon. Members who are acquainted with that report will acknowledge that it recommended the acceleration of improvements for a range of care, including trauma care. The Government support that proposal and expect the London PCTs to agree their forward programme on it tomorrow.

As part of Lord Darzi’s national next-stage review, we have been holding working groups of local clinicians and others in all England’s other strategic health authorities to consider clinical evidence across all areas of health care, including trauma. Those groups have identified what they believe to be the best models of trauma care for patients. Each SHA has now published its vision for the future of health care in its region, based on the recommendations of those working groups. Those visions include improvements to services for seriously injured patients, for example, through the development of specialised centres for the treatment of major trauma to improve outcomes for patients and save lives.

I was interested to read the response, which inspired this debate, from BASICS to last year’s NCEPOD report. It states:

“The public, patients, politicians, managers and the professions need to understand that better outcomes in major trauma are more likely in units staffed by personnel undertaking sufficient throughput and with all relevant specialties to hand. Of necessity this mandates greater regionalisation of services and patients travelling that little bit further to hospital.”

I suggest that that presents a challenge to all politicians who regularly come under pressure from political campaigns to fight to preserve every service that is provided in every local general hospital. It is quite clear from the evidence, which has been widely acknowledged in the debate, that a move to more regional trauma centres will save lives. I hope that when we have such controversies in future, the hon. Members who have spoken today will support their local and regional health bodies and the Government, when we make such a case.

I am happy to set an example and say that I am comfortable with making the case to my constituents in Winchester that some things should happen not at Winchester hospital but in Southampton. If I had an accident, I would much rather go to Southampton. Surely the point is that if I am going to a specialist centre, I want to get there quickly. I am all for specialist centres, but only if people can get there quickly.

I hope that hon. Members who are facing re-election at the next election are prepared to display similar courage when it comes to the reorganisation of health services in their local area. [Interruption.]

I want to update the hon. Member for Winchester and other hon. Members present, most of whom represent constituencies in the South Central strategic health authority area, about the most recent developments there. The SHA informs me that trauma cases in its area are handled by nine acute trusts that have a major A and E department and are classified as receiving hospitals in the event of a major incident. Casualties are triaged and assessed on the scene before being taken to the most appropriate hospital to treat their injuries according to the clinical judgment of paramedics and, if needed, BASICS doctors. They are taken either by ambulance or by air ambulance. If required, BASICS volunteers are activated by the ambulance service for the treatment of casualties on scene, and acute trusts have the ability to activate their own doctors and nurses to form a mobile medical team to assist with the provision of pre-hospital care.

I turn to the hon. Gentleman’s point, which has been repeated in the media, about a consultant in A and E who was a volunteer being told that they could not go to the scene of an incident. I do not know whether that example is hypothetical or real, but it has been raised before. The national clinical director for emergency access, Sir George Alberti, of whom many hon. Members may have heard, is looking into whether there may be merit in the Department’s appointing a specialist trauma tsar to help to drive the national network. The danger is that if we appoint too many tsars, we will reduce their value.

Sir George was asked about that particular case recently on Radio 4. He said that that would not be acceptable, and that clinical priorities should always come first. He said that if someone was making an allegation based on a real example, they should provide him with details and he would look into it, but he has not heard anything more. If the hon. Gentleman would like to, he can furnish either me or Sir George with such an example. We have made it quite clear, as should hospitals, that if there is a clinical need for somebody to go out to the scene of an accident, that should happen—South Central SHA has told me that. Such a person should not be held back in A and E because they are on duty there or because of the desire to hit a target. I wished to put that on record for the hon. Gentleman.

The hon. Gentleman asked whether I have received a request to meet NCEPOD. I have not received such a request, but I have asked to meet NCEPOD about a different matter that came up in the past two weeks, so I am sure that we shall take the opportunity of discussing this matter. As he has acknowledged, NCEPOD has regular meetings with my officials, and its input has been important in helping us to draw up the proposals that we shall publish shortly when Ara Darzi publishes his full next-stage review.

South Central SHA informs me that it is working with the South Central ambulance service to improve the current arrangements for pre-hospital medical teams, by implementing processes to activate mobile emergency response incident teams. That will improve the performance of the trauma system, based on previous major incidents in its region and nationally. It has made it clear in its next-stage review vision document that it wants to improve care for trauma patients. The document states:

“Emergency and urgent care will be provided through a network of A&E departments”


“specialist emergency centres for stroke, heart attacks and trauma.”

On major trauma specifically, its acute care clinical pathway group report recommends that major trauma networks be established, with dedicated major trauma centres and bypass protocols for ambulance services.

That brings me to the issue of the hon. Gentleman’s helipad—well, not his helipad but the one in Southampton. Forgive me, but I am not completely au fait with the likely configuration of any major trauma centre in his region. I suspect that one or two hospitals—or maybe more—are competing for that status. Clearly, his point about access to air ambulances is important, even if it is not necessarily a showstopper. I shall say a little more about air ambulances in a moment.

The hon. Gentleman has said that the chief executive of his local hospital has stated that there is a funding problem. However, I have been informed that Southampton University Hospitals NHS Trust is looking at a £17 million- plus surplus this year. The hon. Member for Hemel Hempstead has questioned the projected costs described by the hon. Member for Winchester, which may be worth consideration. If the hon. Member for Winchester is suggesting that the hospital does not have any money, that is just not the case.

We must be careful in talking about a £17 million surplus, because Southampton hospital is also paying off rather a large loan. One should not be mentioned without the context of the other, and that amount of spare money is not floating around the system in Southampton.

All that I wanted to do was put on record the fact that Southampton hospital is not in deficit. In fact, it is looking forward to what sounds to me like a healthy surplus this year, and how it decides to spend its surplus is entirely its decision.

I wish to say a little about the funding of air ambulances. We had a lengthy debate on the matter in this Chamber back in February, I think, and I do not intend to cover the same ground in great detail—hon. Members who were not present may like to study the Hansard of the debate. In the past, we have undertaken independent research on the cost-benefit of giving more state funding to air ambulances. Before 2002, there was no statutory requirement on, or guidance about, state funding for air ambulances, all of which were wholly funded by voluntary contributions. That has changed, and since 2002 we have issued guidance that the medical staff provided on air ambulances should generally be funded from public money, and that they need to work closely with their local ambulance trusts. My latest information is that that happens in almost all parts of the country, if not all.

There is another point that we might want to discuss outside the debate or in correspondence. I notice from the correspondence that I have received, from parliamentary questions tabled by the hon. Members for Winchester and for Romsey (Sandra Gidley) and from an early day motion tabled by the hon. Member for Winchester, that there is some confusion about a difference between London and the rest of the country, and I shall try to get more details about exactly what that difference might be. The hon. Gentleman has suggested that there is statutory funding in London for the air ambulance, in the way that I have just described, but that is so in most other parts of the country as well, thanks to the change in the policy that we introduced in 2002.

In February’s debate, I made the point that we constantly review the policy. I mentioned that one of the problems in justifying full public funding for air ambulances is that they do not all have a good record at targeting the right sort of cases. I also said that moving to greater regionalisation of trauma care, with fewer major trauma centres, might tip the balance of cost-benefit in favour of more statutory funding for air ambulances. In that debate, I promised to keep this matter under review. I repeat that undertaking today.

I have forgotten for the moment the other issue that I wanted to mention, so I invite hon. Members to intervene.

Just to clarify the Government’s position, is the Minister saying that it is not acceptable that critical pre-hospital care should be dependent on volunteers?

Critical pre-hospital care is not dependent on volunteers, because any ambulance service or acute service will have a range of reactions to a major incident in its area. I have already described the response provided by the ambulance service, which involves having ever-greater skills on board to provide some of the care. Where necessary, teams of doctors will and should be called out to attend an incident to provide such care.

I have also acknowledged that we still have some way to go in providing optimal care, that, generally, the treatment of major trauma has not advanced as quickly as advances in many other forms of care and that we have not performed as well as some other countries. This is partly to do with the different systems in other countries. The hon. Member for Winchester has made comparisons with Germany and the United States, which have different health structures, more specialist centres, different systems and approaches and far higher funding per head of population on health care than in this country.

The Minister is being generous in giving way. Can I clarify what he said a few moments ago? Should medical staff on an air ambulance be funded by the PCT or the trust under the NHS? Are the pilot and navigator, or whatever, the charity’s responsibility, and should the personnel dealing with the medical skills side be funded by the NHS?

I cannot remember whether the hon. Member for Hemel Hempstead attended the February debate—perhaps one of his colleagues was here. This is not a requirement, and we published guidance on the point in 2002. Our information is that in the majority of cases those medical costs are met from statutory funding, which was previously not the case.

I should like to add one more thing about the role of ambulance trusts and their relationship with BASICS. We looked at that matter in a little bit of detail once we knew that this debate had been scheduled. We understand, having spoken to ambulance trusts, that they have clear systems that allow them and their control staff to call on the expertise of BASICS doctors when an incident demands it. As I have said, I hope that the work that is emerging from all the strategic health authorities in the context of Ara Darzi’s visions will help us to improve the way in which we deal with trauma and all the health care pathways that hon. Members care about.

I am grateful to the Minister for giving way. I hear what he has said on the evidence in respect of how things are working. However, what about this statistic? There were 1,200 requests for individuals to come out, but not all those requests were meet. The evidence shows that individuals were not able to go out on 450 occasions last year. Surely, the Minister acknowledges that there is a gap and that something is wrong.

I will study those figures, which I have not seen and do not recognise. I have already acknowledged that we can do more to improve the service provided to people who are involved in trauma before they are admitted to hospital. I promise to write to the hon. Gentleman in response to the particular figures that he has mentioned, but I hope that he acknowledges that, given what I have said, the Government are determined to improve the quality of care for severely injured patients.

I welcome the consensus in this debate that the most effective way to provide the service is through good regional planning and by regional managers and hospital managers working closely with expert clinicians and the local population. I look forward to the recommendations from my noble Friend Lord Darzi’s review and to their successful delivery across the country.

Lance Corporal Compton (Compensation)

I welcome you to the Chair, Dr. McCrea. I also welcome the Minister, who is slowly and surely taking his place, and thank him for taking the time to respond to this debate.

I intend to conduct this debate in five sections. First, I shall make some introductory remarks about my interest in the case. Secondly, I shall be clear about what we want to achieve this morning. Thirdly, I will sketch out the background to the issue. Fourthly, I will run through the key points that need addressing. Fifthly, I shall wrap up with some concluding remarks.

I have two interests in this case—a constituency interest and a regimental interest. The constituency interest is that Lance Corporal Compton lives just—but only just—outside my Faversham and Mid-Kent constituency, in Staplehurst. His Member of Parliament, my right hon. Friend the Member for Maidstone and The Weald (Miss Widdecombe) is, incidentally, fully briefed on this case and is fully supportive. Therefore Lance Corporal Compton and I have the county of Kent in common.

The second connection, which is probably more obvious, is regimental, because we both served in the Life Guards. I served in that regiment from 1982 to 1995, and although three of those years were spent at university, I saw active service in Northern Ireland, with the UN in Bosnia and as adjutant of the regiment during the Gulf war. None of that, it is fair to say, bears comparison with the Army of today, particularly given the intensity of the low-level, hand-to-hand fighting seen in Afghanistan. In a week in which the death toll has reached 100, it is hardly surprising that there have been a considerable number of horrific injuries, such as the one that we are debating today.

I should like, in passing, to pay tribute to the Household Cavalry, which has supported Lance Corporal Compton right through his recovery and will, no doubt, continue to support him in the years ahead. I also pay tribute to Alistair Galloway, a young officer who served with the regiment and who, despite leaving the Army, has continued to help and advise Lance Corporal Compton.

What do I hope to achieve with this morning’s debate? The answer is simple. For reasons that I will outline, an offer of only 57 per cent. of the maximum compensation payable is inadequate recompense for injuries including third degree burns to 70 per cent. of his body, the loss of his ears and nose and complex injuries to his left arm and right leg that will never fully recover. It is inexcusable—I suspect the Minister agrees with me—that Lance Corporal Compton has received no indication whatsoever of the guaranteed income payment, which is effectively his pension, that he will receive for the rest of his life on leaving the Army.

I absolutely do not want to turn this into a party political issue or open up a wider debate about the operation of the armed forces compensation scheme, although that would be a worthwhile outcome. I simply seek to persuade the Minister that he should look again at this case, personally and as quickly as possible, to right what I believe, as a former soldier and current parliamentarian, is a horrible injustice. If the Minister agrees to re-examine this case personally and as quickly as possible, as far as I am concerned that will be a good outcome from this morning’s debate.

What is the background to the case? Lance Corporal Compton was injured in southern Afghanistan on 1 August 2006 while serving with D Squadron of the Household Cavalry Regiment in Helmand province. As the driver of a Spartan armoured reconnaissance vehicle, he suffered third degree burns to 70 per cent. of his body and a gunshot wound to his leg during a Taliban ambush on the vehicle. He was the only survivor of the incident, which resulted in the deaths of three of his colleagues from an improvised explosive device, or IED—I suspect, Dr. McCrea, that you will be familiar with such devices from your own constituency—and a direct rocket-propelled grenade attack. He fell from the vehicle while he was on fire and removed his burning body armour and helmet while coming under fire from the Taliban. He then crawled more than 80 m into cover, where he sustained a gunshot wound to his leg. It is a remarkable story. Lance Corporal Compton was rescued by other colleagues and evacuated to Camp Bastion, where he fell into a coma that lasted for three months, during which time he was revived after “dying” on three occasions. He was then flown to the specialist burns unit at Broomfield hospital in Chelmsford, Essex.

As a result of the attack, Lance Corporal Compton has lost both of his ears and his nose, which have been rebuilt. He has undergone multiple operations to repair his face and body, and he is still having rehabilitation treatment at the defence services medical rehabilitation centre at Headley Court in Surrey. That has enabled him to walk again and to regain the use of his arms and legs, but he will require further surgery and care in the future. It is an extraordinary tale that has clearly resulted in horrific and lifelong injuries.

The case presents two key issues. First and most importantly, the lump sum award made to Lance Corporal Compton under the armed forces compensation scheme does not reflect the severity of the 10 injuries that he sustained or account for the continued requirement for medical care that he will have for the rest of his life, his loss of future earnings—he can never be promoted again within the Army—and the momentous impact that his injuries will necessarily have on his quality of life. In my view, he fully deserves the maximum award, which is capped at £285,000.

Secondly, Lance Corporal Compton has still not received an indication of the guaranteed income payment to be paid annually for the rest of his life, which he is likely to receive on medical discharge from the armed forces—I referred to that point earlier. For fairly obvious reasons, it would be of immense benefit to him to calculate his income for the rest of this life, so that he can plan appropriately for the future.

Those are the two key issues, but the case raises a number of other matters, and I would be interested to hear the Minister’s comments on them. First, the Veterans Agency appears to have paid out the lowest amount available for each of the specific injuries sustained by Lance Corporal Compton. For example, burns to the face and neck are compensated as a tariff level 7 injury at £34,500. However, if Lance Corporal Compton were compensated for the loss of his nose and ears—he has clearly lost them—a considerably higher tariff, which runs up to £86,250, would be used. If the Veterans Agency is going to pick and choose between very different tariffs, surely—particularly in cases such as this—it should choose the higher tariff.

Secondly, the revised award to Lance Corporal Compton does not appear to take account of all his various injuries. As a result, injuries to his arms are included in the award, but there is no compensation for the smoke inhalation injuries that he suffered. If the compensation were calculated for all the different injuries that he received—a lawyer has actually done that calculation—Lance Corporal Compton would have come out above the maximum compensation figure.

Thirdly and far more generally, the armed forces compensation scheme is, as the Minister knows, currently undergoing a review. How long will that review take, and will Lance Corporal Compton’s compensation be reconsidered as a result? If the scheme is upgraded, I hope that Lance Corporal Compton will be in a position to benefit. Finally, there is the question whether the capped level of £285,000 is appropriate in cases such as this where the injuries are so horrific.

In conclusion, in Lance Corporal Compton we have a wholly extraordinary young man who saw three of his comrades killed and who then crawled 80 yd under fire while still alight. As a result, he sustained horrific injuries, including third degree burns to 70 per cent. of his body, the loss of his ears and nose, and the loss of full use of his arms and legs.

In fairness to the Minister and the Ministry of Defence, I accept that it is difficult to reconcile injuries on that horrific scale with a standard formula. However, there is a clear case for the Minister personally to call for this file and to reconsider the case as quickly as possible, with a view to awarding Lance Corporal Compton maximum compensation. I also hope that the Minister will undertake not only to carry out an independent review of the case but to arrange for Lance Corporal Compton to receive an indication of his likely pension—the guaranteed income payment—as a matter of urgency.

In a week in which the death toll in Afghanistan has reached 100, it is appropriate this morning to pay tribute to all those who have lost their lives or been injured on operations. It is vital that all our servicemen deployed on active service know that they will be properly, and I hope generously, looked after if they suffer injury, particularly injury of this severity. As I am sure the Minister will agree, they deserve no less.

I congratulate the hon. Member for Faversham and Mid-Kent (Hugh Robertson) on securing this debate on this very important subject. He rightly raises a number of issues relating to this case that I hope to address today. First, however, I want to express my deep sympathy to the family, comrades and friends of the three soldiers—Privates Nathan Cuthbertson, Daniel Gamble and Charles Murray—who were killed in Afghanistan at the weekend. Of course, my thoughts are also with the loved ones of the other members of the armed forces who have lost their lives, both in Iraq and Afghanistan.

The amount of compensation awarded to sailors, soldiers and airmen who are injured in the service of this country, and to the families of those who sadly have lost their lives, is a very important issue that matters greatly to individual service personnel and their families.

I know that, as the hon. Gentleman said, he served in the same regiment as Lance Corporal Martyn Compton and I congratulate him on his distinguished service. I am sure that he will join me and the whole House in recognising and paying tribute to the courage, professionalism and commitment shown by Lance Corporal Compton and all members of the armed forces, and by the families who support them. Of course, I congratulate the Household Cavalry on the support that it has shown for its injured service personnel, particularly Lance Corporal Compton.

I want to say at the outset that the Government are fully committed to meeting our duty of care to serving personnel, veterans and their families. As has been recognised by many organisations, including the Royal British Legion, we are making improvements, including to service pay, accommodation, health and welfare provisions, force protection and personal equipment. Of course, however, we recognise that there is still scope for further improvements. That is why we are working on a cross-Government Command Paper on personnel, which will examine a range of issues to see what we are doing well, what we could improve on and what it is possible to achieve.

The hon. Gentleman raised the issue of the review of the armed forces compensation scheme, which I announced recently and for which we had asked. I cannot give him a date at this stage as to when we can say something further, but the fact that we are reviewing the scheme is important in itself.

I of course want to join the hon. Gentleman—I am sure that all hon. Members do—in wishing Lance Corporal Compton the speediest possible recovery from his condition and the injuries that he has received. I met him last week to discuss both his experiences of welfare support and the compensation issues. I regularly meet injured personnel; I make a point of meeting them at Selly Oak hospital, Headley Court or elsewhere.

A number of questions have been raised today about the particulars of Lance Corporal Compton’s case. I am sure that the hon. Gentleman will understand that, while I am happy to discuss such issues with Lance Corporal Compton directly, it is only appropriate that I confine my remarks this morning to the support, compensation and welfare available to the armed forces in general, rather than discussing the particulars of one case, as important as that case is.

There are a couple of issues that I will respond to. Lance Corporal Compton raised the issue of the notification of the guaranteed income payment with me last week, and I assured him that we will get him an assessment of what that payment will be, based of course on his current salary, because the amount will depend on what his final salary is. We will carry out that assessment and such assessments will be made for other injured service personnel in the future, too.

The hon. Gentleman asked a specific question about medical care and compensation. While Corporal Compton is in the care of the armed forces, that would be provided either directly through the armed forces or through the hospital that we use in his case. Thereafter, responsibility will fall to the national health service, which will be responsible for ensuring that the highest possible standard of medical care is provided. We have been working closely with the Department of Health on these issues over recent months, and, as part of announcements that I made several months ago, a case officer will now be allocated by the Service Personnel and Veterans Agency to work with and help the most seriously injured personnel, certainly in the first two years and thereafter if necessary, if they are discharged. As I said, that is a new initiative.

The armed forces compensation scheme came into effect in April 2005. For the first time, it provides for a lump sum payment to be made to serving members of the armed forces who are injured due to service. I stress that this is the first time that compensation is being paid in-service to injured service personnel. That is an important step forward and an improvement made by this Government.

The lump sum award compensates for pain and suffering and is made under a tariff-based system that is informed by existing established models such as the Judicial Studies Board guidelines for the assessment of general damages in personal injury cases, and the criminal injuries compensation scheme. We review the tariff levels periodically, and, as I announced to the House in April, such a review is under way.

The most seriously injured are also awarded a guaranteed income payment, which we have just discussed. I stress that it is a tax-free, index-linked payment made every month from discharge for the rest of the individual’s life; it does not stop at retirement. That important point often gets overlooked—deliberately so by sections of the press. The guaranteed income payment is part of the whole compensation package.

When we constructed the scheme, we listened to the advice of ex-service organisations to give lifetime financial security, rather than adding to the lump sum in the initial award, as is done in some civil cases. Again, that is an important point. We could have made it all part of a lump sum, but we did not. We thought that income for life was an important aspect of the compensation.

I believe that the guaranteed income payment provides better support for our servicemen and women, but, regrettably, it means that the true value of an armed forces compensation scheme award is not always readily understood. I stress again that the guaranteed income payment is part of the whole package. Between the lump sum and the guaranteed income payment, individuals can receive hundreds of thousands of pounds over a lifetime, and, unlike other compensation schemes such as the criminal injuries compensation scheme, the armed forces compensation scheme has no monetary cap.

To give an example—I stress that this is an example, but one that is worth tabling—a 25-year-old soldier earning £22,000 a year who is very seriously injured may receive up to the £285,000 maximum lump sum. He will continue to be paid while in service, including during rehabilitation, which may last for several years. On discharge, he will receive a guaranteed income payment of around £19,000 per year, which will be tax-free and index-linked. That is an example, but it shows the sort of payments that can be made. By the time the individual reaches the age of 45, he will have received £380,000 by way of a guaranteed income payment. By the time of his 65th birthday, he will have received some £760,000 plus the lump sum. I stress that the guaranteed income payment figures are baseline amounts and are, in fact, uplifted year on year to take account of inflation.

As the armed forces compensation scheme is relatively new, we keep it under review in the light of experience. For example, in common with other injury schemes, the armed forces compensation scheme contains a multiple injury discounting rule to prevent those with a large number of relatively minor injuries from receiving more than someone with fewer, more serious injuries.

That is the nub of the problem, is it not? I entirely accept the logic of the situation, but there is a reverse effect, whereby if the injuries are as severe as they are in this case, the tick-box method on the form may not be capable of reflecting the absolute severity of the injuries suffered by this young man.

That is the nub of the whole debate, which goes slightly wider than that, but I accept the hon. Gentleman’s point and it is an important one to make. At the end of the day, what payment is enough for our injured service personnel? Many people have different views on that—I will probably return to that a little later—but I stress that the point about what would be enough is important. We have to base the scheme on past practice and on other schemes to come to a conclusion about the sort of scheme that we should offer. As I said, we based this scheme on the Judicial Studies Board and on precedents that have been set. No scheme is perfect, but the key issue is whether those with the most serious multiple injuries get the best award. I accept that the point is important, but it is not straightforward.

At the end of last year, we recognised that the scheme was not fully meeting its policy intent of focusing resources on those who were most seriously injured. We therefore changed the rules relating to those who suffered multiple injuries from a single incident, better to reflect the serious and complex nature of some of the injuries that servicemen and women were receiving on operations. That was widely welcomed as a step forward. It is important to stress that the armed forces compensation scheme addresses pain and suffering, as well as the loss of earning capacity.

Individuals leaving the services also have access to all the state benefits that cover the other elements of civil compensation awards such as the NHS, which I have mentioned, for ongoing treatment, the disabled facilities grant for home adaptation, and the disabled living allowance for care. For instance, I know that the homes of some service personnel who are still in service were adapted to take account of disability.

It is worth reminding ourselves that any member of the armed forces injured due to service has access to these awards on a no-fault basis—this is a key point—without there being a need for negligence on the MOD’S part or for a time-consuming and costly legal process.

As I said, there are a variety of opinions about what the right compensation should be for those injured while in service. No amount of money can adequately compensate for some of the more serious injuries received by our armed forces personnel, but the armed forces compensation scheme does deliver no-fault compensation for those who are injured and for the families of those who are killed as a result of their service in the armed forces.

Of course, welfare for injured service personnel is much broader than the compensation. This is an important point: medical care is often caught up in the wider welfare provision for injured service personnel. I want to make a few important points about medical care, which starts with the care that they receive in theatre and, for the more seriously injured, continues with the clinical care that they receive once they are returned to the UK for specialist treatment.

Since 2001, the Royal Centre for Defence Medicine, which I visit regularly, based at the University Hospital Birmingham Foundation Trust, has been the main receiving unit for military casualties evacuated from an operational theatre. The clear view of all the injured service personnel and families whom I spoke to during my last visit was that they were being really well looked after. There were no complaints about the care that they were receiving.

In the Birmingham area, military patients can benefit from the concentration of five specialist hospitals, including Selly Oak hospital, to receive an excellent level of clinical care. Indeed, I and many others believe that Selly Oak is at the leading edge in the medical care of the most common types of injuries that our casualties sustain. If there is a need for urgent specialist treatment that cannot be immediately provided in the Birmingham area, we ensure that the patient is admitted promptly to a unit elsewhere in the UK that specialises in the particular injury, such as the burns unit at Broomfield hospital.

The Defence Committee recently described the treatment available to troops injured on operations as “second to none” overall—an assessment that I share, having visited our patients and staff in field hospitals in Iraq and Afghanistan, as well as in NHS hospitals in the UK. All veterans now receive priority care on the NHS after discharge for conditions caused by their service. The NHS recently reinforced that message.

If military patients require further rehabilitation following initial hospital treatment, they may be referred to the Defence Medical Rehabilitation Centre at Headley Court in Surrey, which is widely recognised as delivering first-class specialist rehabilitation of complex cases. The Government recognise that continuing investment is needed to ensure that Headley Court retains its reputation as a centre of excellence, and have recently announced that they will invest an additional £24 million in the Headley Court site over the next four years to maintain and enhance its capabilities. The new investment, together with current funding for new facilities, means that Headley Court will see an investment over those four years totalling some £24 million, in addition to substantial funding that the charity Help for Heroes intends to provide for the new rehabilitation complex. We also adapt service accommodation, where appropriate, for injured personnel who are able and willing to continue their service career. That is another important point. Many injured service personnel remain in service.

Injured personnel also receive welfare support during their treatment and convalescence. Visiting officers, available on 24-hour call-out duty, maintain regular contact with injured service personnel. The Birmingham welfare office supports the hospitals in that area, there are regular welfare surgeries at Headley Court and the veterans welfare service contacts seriously injured personnel before their medical discharge. In combination, those services provide support to injured personnel and their families throughout treatment. We have also increased community psychiatric and nursing support.

No amount of money can adequately compensate for some of the serious injuries received by our armed forces personnel, but the Ministry of Defence can and does ensure that those injured in service are provided with exemplary health care.

I thank the Minister for his remarks about the armed forces compensation scheme and his commitment to ensuring that Lance Corporal Compton gets a proper indication of his guaranteed income payment. Will he also look again at the file? I accept that no figure could possibly compensate that young man for his injuries, but for better or worse, there is a figure of £285,000. I, as his representative this morning, would like to ensure that he receives the maximum sum possible for his injuries under the scheme. Will the Minister undertake to look again at the file to see whether that is possible?

The straightforward answer is yes. I said to Lance-Corporal Compton last week when we discussed the nature of the injuries and how they were compensated that I would look at it, and I will.

As I was saying, the Ministry of Defence can and does ensure that those injured in service are provided with exemplary health care, a compensation award to reflect the pain and suffering that they have experienced, welfare support and, in the cases of the more seriously injured, a tax-free income stream for life to reflect the loss of potential earnings and pension. I reiterate, because the press often deliberately overlook it, that we provide a guaranteed income payment that can amount to hundreds of thousands of pounds during a lifetime.

I believe that we are supporting our armed forces personnel and their families to a much greater degree than ever before. We can always look to see what can be improved, and we continually review what we do for our armed forces personnel and veterans and their families. That is why we are reviewing the compensation scheme. I cannot give the hon. Gentleman a time scale or tell him what the conclusion might be; I can only say that the fact that we are reviewing it indicates that we are not sitting back. We always listen to the contributions and representations made to us. We will make an announcement at the appropriate time.

Sitting suspended.

Minimum Wage

I am delighted to have the opportunity to introduce a debate on enforcing the minimum wage. I am raising the issue in the House this afternoon because of a recent case from my constituency, which in turn highlighted a number of wider problems with the national minimum wage and its enforcement.

The national minimum wage is one of the big success stories of this Government. By one estimate, its introduction has brought at least 1.3 million people extra income and it has been particularly beneficial for women, who make up 70 per cent. of the beneficiaries. Part-time workers have also benefited—about two thirds of the jobs affected have been part time. Despite the hysteria in some quarters when it was introduced—I am referring to the official Opposition—the national minimum wage has not cost jobs; in fact, the evidence is that it has created jobs.

It is a success story, but to reap the full benefits the national minimum wage must be enforced. Minimum wage enforcement teams throughout the UK have had a degree of success. According to figures given in various sources, in the past year the teams identified more than £3 million in underpaid salaries throughout the UK, and they have helped to return more than £27 million to about 80,000 underpaid workers since 1999. To give an example, recently, as a result of only one call to the helpline, 180 employees of a company in the London area shared a total payout—they were owed the money, of course—of more than £100,000.

Many cases, however, slip through the net, which is what I want to concentrate on today, and in particular on one case from my constituency. About two years ago, a woman, a foreign national, who worked in a restaurant, came to my surgery with her partner. I will not give her name for reasons that will become obvious when I recount her story. She was on low pay and discovered that she was being paid less than the national minimum wage. She found out about the wage and how to assert her rights. She complained to her boss, but made no progress on receiving her rightful minimum wage. After a while, her boss sacked her because of her requests.

My constituent complained to the national minimum wage helpline. She was here legally and had a work permit, but its terms required her to find a new employer within four weeks if it was not to become invalid. However, her boss let it be known to others in that sector of the restaurant trade that she was a trouble-maker because she complained that she did not get the minimum wage, so she had difficulty finding a new employer. Thanks to the intervention of the Department responsible for such things at the time—it was either the Home Office or the Foreign and Commonwealth Office—she was given an extension on the period in which to find a new employer to three months, and was able to get a new job and stay in the UK.

My constituent worked with the national minimum wage enforcement unit to try to get the money that she was due from her previous employer, and they worked out that she was due more than £6,000 in back pay because of the low wage that she had received. I intervened to try to sort out the difficulty caused by her work permit, and was in contact with her up to the stage at which she was trying to get the £6,000 she was owed. I thought that the case had been solved, that there had been a satisfactory result, and that the woman had got her due rights.

However, a few weeks ago, my constituent came to my surgery with the same problem, because the story did not end as happily as I thought it would. I was told that the enforcement unit, because of a heavy work load, had not been able to bring the case to a conclusion in almost two years. During that time, my constituent’s family had been threatened with violence, presumably to persuade her to withdraw her claim here in the UK, and the employer resisted making payments. Eventually, at the request of the enforcement unit, which wanted to bring the case to a conclusion, my constituent agreed to settle for a lesser sum than she thought was due. She agreed to receive £4,000 and, as I understand it, an order to that effect was made by an employment tribunal, after which her employer, which was a limited company, went into liquidation without paying her a penny. She is pursuing the matter as best she can, but the outcome was that when she tried to enforce her rights, she found that the enforcement unit was unable to act as quickly as she felt it ought to. As a result, she has not received a penny for the wages that she was due some two years ago.

I emphasise that my constituent does not complain about the individual officers in the unit; she feels that they worked very hard to help her with her case. She was told, however, that the officers’ work load was such that they were not able to put the time that they would wish into individual cases.

That case led me to make inquiries about the enforcement of the national minimum wage, and it now seems to me that there are a number of ways in which to make enforcement more effective. According to the Government’s estimates, almost 300,000 UK workers are being paid less than the minimum wage. I shall not go into all the case studies that I have seen because of the time, but organisations such as Citizens Advice suggest that it is a big problem in many areas of the UK. Indeed, since the national minimum wage was introduced, there have been only three successful criminal prosecutions for offences involving disregard of national minimum wage regulations by employers. Many more cases resulted in payments of back pay, but criminal prosecutions have been rare.

We had a similar debate on poverty a week or two ago. Does my hon. Friend recall the last pre-Budget statement by the Prime Minister when he was Chancellor of the Exchequer? He announced that the Government were increasing the resources to tackle non-compliance by 50 per cent.—£3 million or more. Does my hon. Friend know how that money was used? There appears to have been a steady growth in the number of cases of failure to pay the national minimum wage, not only by direct employers but by outsourcing at arm’s length through agencies. The latter arrangement is difficult to tackle.

My hon. Friend raises a good point and the Minister will doubtless answer his question. Certainly, more resources have been put into enforcement of the national minimum wage—I was coming to this point—some of which have gone into hiring an extra 20 enforcement officers, which is welcome. Various tougher penalties are being imposed upon employers who break the law, which I also welcome, but more needs to be done on grass-roots enforcement to get the full benefits to those who deserve the Government’s support to get the wages that they are due.

I congratulate my hon. Friend on securing an excellent debate this afternoon. Given the context of his constituent’s case, have any criminal charges been brought in Scotland, where there is a separate jurisdiction for criminal law? Does he believe that the staff in the minimum wage enforcement unit are familiar with the practices under Scots law and is there sufficient co-ordination between them and the Justice Department in Edinburgh?

I hazard a guess that my hon. Friend thinks that the answer is no. Nevertheless, she raises an important point. The unit has to take account of the situation in different parts of the United Kingdom, particularly where a Department in another Government has some responsibilities in this area and where there is a separate legal system. My hon. Friend makes a good point to which I hope the Minister will respond today, or at a later stage. I do not know of any prosecutions in Scotland. That is important, because as well as enforcing legislation, prosecutions of this nature are an effective means of giving an exemplary reminder to employers who do not meet their duties of what can happen if they do not fulfil the requirements of the minimum wage.

I recognise that the Government have put in extra staff and resources, which is good news, and hopefully that will lead to results. We must look seriously at providing more staff and resources to enforce the minimum wage on the ground. From what my constituent was told by the officers concerned, her experience was that they felt unable to keep up with all the complaints made to them as quickly as they would like to. More staff resources should bring results in terms of real cash going to people who are not getting the money to which they are entitled. There needs to be an investigation, at least, into providing more staff.

From the story that my hon. Friend related earlier, it appears that a lot of low-paid workers are too intimidated to apply for an inspection to allow them to be paid the minimum wage. Would it not be better to have a much more rigorous, proactive inspection regime in which employers are checked regularly by inspectors to ensure that they are paying the minimum wage, rather than leaving the onus on employees to make a complaint in the first place, because they might be intimidated into not doing so?

My hon. Friend makes a good point, particularly given that in certain sectors, about which all hon. Members know, there is more likelihood of exploitation of the type he mentions and it is more likely that people will be paid below the minimum wage. One statistic suggests that, on average, a business could be expected to be visited once every 330 years by wage inspectors. In some ways that is a meaningless statistic, but it makes the point that there is in respect of certain sectors a strong case for much more proactive enforcement of the minimum wage regulations.

The role of the employee or other members of the public in reporting non-payment of a minimum wage is crucial. We need to consider making changes to the publicity of the national minimum wage, so that people can understand what it is, what they are entitled to and how to complain about non-enforcement. There are advertising campaigns, which I welcome, including a recent national and regional online advertising campaign, which may still be ongoing. A bus campaign has visited many parts of the UK; however, I understand that there is just one bus, not a fleet of buses. One bus will take quite a while to reach most parts of the UK, even allowing for fast progress between different locations. That suggests that we should pay more attention to publicity.

We need to do more to target ethnic minority workers, who are often underpaid and are often, for all sorts of reasons that hon. Members can appreciate, the most vulnerable in respect of irresponsible and criminal employers. There is material in ethnic minority languages, and other work of that nature is being done. However, from my knowledge of my constituency—I am sure that this is replicated elsewhere—a lot more could be done to make a particular effort to target ethnic minority workers in their workplaces and where they gather, and through their media outlets and in other ways.

May I apologise for arriving late, Dr. McCrea?

Would it be appropriate to ask local authorities, which are major employers, to make sure that the minimum wage is part of the subcontract detail when they subcontract? They should be ensuring that the minimum wage is paid.

Indeed; that is another important method that could be used.

I mentioned targeting publicity on the enforcement of the minimum wage at ethnic minority workers. This is a delicate area at the moment in some political debates, as colleagues will recognise. However, there is an issue—there is no point in hiding it—in many parts of the country where there is a feeling that ethnic minority workers can undercut UK workers. That is actually happening in some cases—there is no point in denying that—and it leads to all sorts of tensions and resentments between ethnic minority workers and the UK citizen work force. Of course, ethnic minority workers are not necessarily UK citizens.

One of the best ways of reducing the possible tensions is to remove as far as possible the opportunity for people to feel threatened by being undercut for their work, and to prevent their being paid less than the national minimum wage. The more that we can do to ensure that ethnic minority workers get at least the national minimum wage and are not exploited, the more we benefit the resident UK work force, be it ethnic minority or not. We can do a lot to benefit ethnic minority workers and the wider work force, and to benefit or improve inter-community relations in a way that leads to a win-win situation.

Having spent time in Crewe toward the end of the recent by-election campaign, I heard a lot of anecdotal evidence on the doorstep—no doubt this is so in lots of other towns throughout the country—that eastern European workers were undercutting in ways that breached the national minimum wage legislation. Is it not possible for the Department for Business, Enterprise and Regulatory Reform, the Department for Environment, Food and Rural Affairs or Her Majesty’s Revenue and Customs to establish a roadshow, for example, to promote the minimum wage and act as a point of reference in towns from which complaints are received, in order to put the case in the public spotlight?

That is a good point. My hon. Friend mentions anecdotal evidence. It may be anecdotal but it is also true: such anecdotes are soundly based. There are instances of migrant workers, rather than ethnic minority workers, being exploited in this way. The more we direct efforts to ensure that they are not exploited, the more everyone benefits, including both the migrant and the domestic work force.

I have been involved in campaigns in my constituency with trade unions and representative organisations from migrant worker groups. Although some material on these issues in various languages is available from Departments and from the Trades Union Congress and other organisations, not a lot of material is available and there is not a lot of easily accessible information that could allow maximum take-up of these rights by both UK and migrant workers, who might be from ethnic minorities.

Is my hon. Friend concerned, as I was, about a recent report in The Guardian, which said that, until there is an increase in expenditure on advertising the minimum wage hotline, the amount spent by the Government is a sixth of that spent on a recent Government campaign urging people to use tissues when they sneeze? Does he not agree that now is the time for us to give this issue much greater priority throughout the UK, particularly, as he has mentioned, for ethnic workers and low-paid women?

My hon. Friend makes a powerful point that, unfortunately, has taken away the last, ringing point that I was going to make. That again highlights the fact that, despite the number of workers who are entitled to and receive the national minimum wage, there are still too many who are not getting that to which they are entitled.

I return to where I started. Introducing the national minimum wage is one of the biggest success stories of this Labour Government, and we should do everything that we can to ensure that all those who are entitled to it receive it. That requires spending money to bring about reinforcement. Spending money in that way will benefit not just the workers concerned but the wider community. In some cases, it may also benefit the Exchequer. As people receive more income, they will enter the wage system in a way that they previously did not. For all those reasons, I urge the Minister to consider ways in which her Department, working with other Departments, can increase the uptake of the national minimum wage. I look forward to other hon. Members’ contributions to this debate.

I congratulate my hon. Friend the Member for Edinburgh, North and Leith (Mark Lazarowicz) on securing this very important debate. Many constituencies face issues that reflect his concerns about non-enforcement.

I do not want to give three cheers for the minimum wage, because it deserves only one cheer—possibly two, at a stretch. We know the stories: £1.50 an hour in the security industry and £1.50 an hour in the forestry industry before the minimum wage. I remember my hon. Friend the Member for Dumfries and Galloway (Mr. Brown) telling us about the wage rates in his local industry. The reality is that the wage rate has become a poverty trap for many workers. People are being paid less than they would if we had proper trade union legislation and if we returned to the system of industry wage councils, which worked well before they were collapsed by the Conservative Government to allow massive exploitation and the driving down of wages to the point at which people were getting £1.50 an hour.

When we introduced the wage in 1999, it was £3.60, which was far too low. We were afraid of the propaganda that was put out by the Conservatives and by many people in British industry who did not want to see any security for workers. They were quite happy to use the exploitative environment in which the Conservatives had left the working people of this country after 18 years of misrule. The rate was too low, and it has not risen quickly enough. The adult rate of £3.60 has risen to £5.52. It will go up again in October. That is a 53 per cent. increase. It has only gone up by half from a very low base since 1999. That is an average of 6 per cent. a year.

People may say that that is great and that 6 per cent. is a lot more than people are receiving on average. However, it is certainly not comparable with the massive rip-off wages of the people who work in the City or the people who have exploited the oil resources of this country. The finance markets and the domestic markets for fuel are in an unacceptable state, yet the wages returned to those people have gone up by hundreds of per cent., rather than by 6 per cent. per annum.

I want to speak about the development rate. What is a development rate? Where did that phrase come from and what does it mean? The former Minister, my right hon. Friend the Member for Makerfield (Mr. McCartney), is here and he put it through, but it is a mystery to me what development is supposed to go on between the ages of 18 and 21 that justified us giving people only £3 an hour instead of £3.60, and at this moment only £4.60.

We made one major improvement in 2004; we recognised that those aged below 18 were being ripped off lock, stock and barrel, because they were not covered by the minimum wage until 2004. Therefore, industries such as burger bars and shops would employ young people aged between 16 to 18, because they were not covered by the minimum wage. At least, we have corrected that. Although we have not given them a great deal, we have at least brought them into the structure.

There is an argument that, at 16 and 17, people should be encouraged to stay in school and not go into employment. Sadly, in my constituency, there are still many people who leave school and end up not in employment, education or training. Eventually, they end up in some low-paid, temporary and pointless job, which pays them a small wage.

What is a development wage? At the age of 18, a young person can fight and die for their country. They can go out on the front line of a battle and die. They can legally drink in a public house and legally purchase alcohol, and by the age of 21, they can do anything that any citizen would wish to do. They can vote at 18, but they cannot get a man’s wage. I married when I was 21 and my wife was 19. If we had been that age now, we would be getting paid a development rate if we did not have some other way of finding employment. I used to go out and work on a building site. I did that before I was married; during the holidays I married, and I went back on to that building site. I was paid a man’s rate, because I did a man’s job.

Today, when a youngster goes on to a building site, someone does not say, “You’re getting less of a job and you’ll get development.” No, they are given a pick and shovel, or some other implement, and told to get in there and work with the rest of the squad. So what is the development rate about? It is a sop to the rip-off merchants who run many of our industries today.

In the retail industry, which is prevalent in West Lothian, everyone who works in a shop is paid the minimum wage or below—they are paid the minimum wage, but they are below the age of 21, so they get £4.60. The top rate of pay for the supervisor who runs the shop is £6.40 an hour. That is the environment to which people have been driven, partly because the minimum wage is so low. It is reprehensible, and we should have done what the trade unions suggested at the time and set the wage at half the median income for the country. Until we start thinking about that and about giving every 18 year old and above the same rate of pay as everyone else on the adult minimum wage, we are offending greatly against the principles that I certainly came into the Labour party to pursue.

I now want to turn to my pet subject—the Minister probably anticipates this—of the minimum wage and the treatment of tips. The famous regulation to which I refer is not in the National Minimum Wage Act 1998. It is so well hidden in the National Minimum Wage Regulations 1999 that when I talked to Professor George Bain, who chaired the Low Pay Commission for four years, he said that he did not know that it existed. He did not know that such things went on. Regulation 31(1)(e) says that, if tips are paid through the payroll, it counts towards the minimum wage. For 2 million people working in the hospitality industry, a large number get their wages from their tips. The minimum wage is not a wage with an addition for the tips that we give them; it is made up of those tips.

What is a tip? As defined by Her Majesty’s Revenue and Customs, everything that is a gratuity, tip, service charge or cover charge is a tip. It has defined that quite clearly for the purposes of tax and national insurance. When we enter a restaurant and it says at the bottom of the bill, “A 12.5 per cent. service charge has been added to this bill”—sometimes it says that that is voluntary and sometimes it does not—we are paying a tip. If we pay that on our credit card—this matter has been judged all the way up to the European Court of Justice—we are paying it to the owner of the restaurant or the hotel premises that we are in. However, if we pay cash and it is paid through a kitty or tronc, which it mainly is, and it goes through the payroll, it still counts towards the minimum wage. So if we give cash, we might not be giving it to the proprietor, but we are still paying the minimum wage with it.

After I introduced a ten-minute Bill in the House, I discussed the matter with the Minister and officials from the Low Pay Commission. I say pejoratively that I found them to be useless. They said, “If we take that away, and tips are in addition to the minimum wage, we will have to find out how much tips people are getting and enforce the tips.” However, that is not correct. All they have to do is ensure that people get the minimum wage. The law should say that everything that is paid as a tip or gratuity will have to count on top of the minimum wage. That would redress the balance between the customer and the person who is serving them.

The French word for a tip is a “pourboire”, which means “for to drink”. That is what a tip is: an additional sum of money on top of someone’s wages that they can have some leisure or pleasure with, but that is not so in this country. In this country, because of the regulation I have referred to, tips are paying the wages—a minimum wage—of many people in the hospitality industry. It is time we stopped that. It is also time that we paid a decent minimum wage and the same rate to all adults. People who are above the age of 18 are adults—they have adult responsibilities, and they usually work an adult shift.

If we get rid of the tips anomaly, people who work in the hospitality industry, particularly in this city, would find that they are due what they are given by their customers. If people want proprietors to get more money, put up the cost of the facility or the food. Anything on top of that is what the customer chooses to give as an extra to the staff for the quality of service. That would redress some of the imbalance that occurs at the moment. The issue was recently illustrated by the Daily Mirror and Unite launching the fair tips campaign, which called for a fair tips charter to be displayed by good premises that pay the minimum wage, on top of which tips are paid. I hope that the Government will shortly do something to correct the tips anomaly.

Although it was a huge step forward when Labour brought in the minimum wage, which benefited millions of the lowest paid workers, it is appalling that estimates from the Office for National Statistics show that around 300,000 workers are still in jobs that pay below the minimum wage. As we all know, that is only the tip of the iceberg.

I congratulate my hon. Friend the Member for Edinburgh, North and Leith (Mark Lazarowicz) on securing this timely debate, and I very much agree with the points that he made about strengthening staffing resources and publicising enforcement. I also agree with the point made by my hon. Friend the Member for Linlithgow and East Falkirk (Michael Connarty) about 18 being recognised as the age at which the adult entitlement for the minimum rate should apply, and I think that we all found his arguments persuasive in relation to his convincing obsession with tips.

Although progress has been made on the minimum wage, part-time workers, maternity and paternity rights, holiday entitlement, the rights of union representation and the recent agreement on temporary and agency workers, a great deal remains to be done. That was graphically illustrated in the excellent and chilling report, “Hard Work, Hidden Lives”, by the Trades Union Congress commission on vulnerable employment. The report sets a compelling agenda on which the Government must act further to improve workers’ rights and to ensure that they can access the rights that they are already supposed to have. We must have more debates and campaigns on the wider issues to keep these vital matters at the forefront of people’s minds and to secure further progress.

I shall focus on two particular points about minimum wage enforcement that have been brought to my attention by my trade union—the Union of Shop, Distributive and Allied Workers. My hon. Friend the Member for Linlithgow and East Falkirk referred to the important role of trade unions in these matters. We all have a responsibility to act to counter such abuses, but we must respect and recognise the role that trade unions can play.

I want to make the case that third parties should be able to take representative or group cases to employment tribunals to enforce the minimum wage. At the moment, underpaid workers request that they get their due by contacting the minimum wage helpline and taking a case against the employer to an employment tribunal. Every worker who believes they have been underpaid needs to be named on the application, otherwise they will not be affected by the case, even if they are underpaid.

As we know, if an employer is underpaying one member of staff, in most cases, others are also being underpaid. Workers who are being paid less than the minimum wage are some of the most vulnerable people, as we have heard. Most fear losing their jobs if they take action against their employers to demand the higher pay to which they are entitled. The system identifies every such worker and leaves them vulnerable to reprisals from the employer, as we heard in the awful case raised by my hon. Friend the Member for Edinburgh, North and Leith.

There are obvious difficulties related to those circumstances and to persuading workers to put their name on an employment tribunal application—let alone being the first on the list. Although workers are protected from day one against unfair dismissal for enforcing the minimum wage, as we know, there are all sorts of ways that an employer can make it impossible for a vulnerable worker to continue their job—for example, unreasonable shifts, denying holiday requests, changing job content, and so on. Many cases of minimum wage underpayment are therefore never brought and that allows unscrupulous employers to think they can get away with it.

To move forward to a solution, we need to revisit the present restrictions whereby trade unions and other third parties are prevented from any involvement in cases of minimum wage enforcement. If a third party makes a complaint to Her Majesty’s Revenue and Customs, they are not even allowed feedback on the outcome of the case. I should be grateful if my right hon. Friend the Minister addressed that in her reply. As we know, representative actions and group litigation orders are allowed in the courts in certain circumstances. Therefore, it seems anomalous that employment tribunals cannot hear representative action and that their powers to manage group litigation in a way that would help to defend low-paid workers from exploitation are less extensive than those of the courts.

I shall try to hurry through my comments, because other hon. Members want to contribute. A further point relates to the wider remuneration package and employment issues. I want to put the case for HMRC minimum wage enforcement officers to be given the powers and training to enforce wage-related employment rights, including rights to paid holidays, statutory sick pay, maternity and paternity pay. Presently, if an employer fails to pay the minimum wage, they often also deny their staff other rights, including holiday leave, sick pay and maternity and paternity pay.

Even if minimum wage enforcement officers find evidence for such underpayments, they do not have enforcement powers. The only option for a worker to enforce their entitlement to those rights is to take an individual case to the employment tribunal. However, there is no protection against unfair dismissal for a worker who has been in employment for less than one year and who is seeking to enforce their legal rights to such payments. As I said, even if an employee has been in the same job for more than 12 months, an employer can find numerous ways to make it difficult for them to stay in their job and complain about their rights. There is little recourse for vulnerable employees who have been denied those payments. That makes the employment rights that we are proud to have carried forward under this Government of limited practical use to the most vulnerable employees, about whom we should be most concerned.

Given that HMRC inspectors have considerable expertise in dealing with wage issues and unscrupulous employers, there is surely a case for extending their role. With additional training, they could seek out and enforce compliance with the other wage-related employment rights issues. They could also ensure that vulnerable workers are protected and that employers have more to lose than they presently do from evading the law.

The introduction of the minimum wage and other employment rights has been a huge step forward. However, if all workers—particularly the most vulnerable—are to enjoy the minimum civilised standards for which we surely all ought to be fighting, enforcement needs to be strengthened, including in the ways that I have suggested.

It is not often that former Ministers are present in debates such as this, not to defend themselves, but to think aloud about where we should take things.

My hon. Friend the Member for Linlithgow and East Falkirk (Michael Connarty) said that he would give the minimum wage two out of three; I would give it three out of three. That is not because I was the Minister responsible for it or because I am totally loyal to the Government, which I am on two counts—one historical and one factual—but because, 10 years ago, a debate such as this would have been about the principle of the minimum wage and whether it is a viable option in a modern labour market. That argument has been won. Conservative Members sit over there, but there is absolute, or almost absolute, silence from them. Yet, the Conservative party tries to convince us that it is an anti-poverty party.

We started a campaign to establish the Low Pay Commission, and the national minimum wage is now a reality. Under their contracts, constituents working in Burger King were earning 10p an hour. When there was no work for them to do in the early evening, they had to sit and wait until their employer told them to get back behind the counter. While they were waiting, they got no pay whatever.

When the national minimum wage started, it was £3.60 an hour, which was not a lot of money, but it was better than 10p an hour. The big thing about the minimum wage, however, is that it is not just a minimum wage; it is about the state taking responsibility for its citizens—for workers who are vulnerable, disorganised or unorganised and who do not have the capacity, individually or even collectively, to negotiate better pay and conditions.

Whatever the rate of the minimum wage in the future, it will always be just that—a minimum wage. For many workers at the edges of the labour market, it will always be vulnerable, and there will always be employers who are prepared to undercut it. If we accept that that is the reality, we have to ask what we, as parliamentarians, can do to improve the system in the light of our experience since the implementation of legislation.

Everyone in Parliament who followed the minimum wage process from concept to reality will commend my right hon. Friend’s efforts to promote it and to tackle issues relating to temporary workers and the working time directive. We all owe him a debt of gratitude, and every worker in the country should realise that.

I thank my hon. Friend for that. I was not being defensive. I was one of many people involved in the process, and the truth of the matter is that I was lucky to be the right person at the right time. Although I was certainly enthusiastic about the job, it was a collective agreement.

The consultation on the Employment Bill will take its course, and I hope that the Government will respond positively to the recommendations that USDAW, Unison, the TUC and others have made to improve its workings. I want, however, to concentrate on the current regime.

We asked HMRC’s predecessor to take responsibility for investigation and implementation because it was the one organisation that had the capacity to look at employers who refused to pay the minimum wage on request or as a simple matter of principle. Those were the same employers who refused to introduce minimum health and safety standards and who failed to recognise trade unions, pay appropriate tax and national insurance contributions and do all the other things that a good employer does as a matter of course. HMRC is the one agency that has the capacity, intellectual ability and skills mix to have a relationship with every employer in Britain. It is a powerful tool in implementing a national minimum wage and dealing effectively and quickly with those who refuse to pay it.

First, it was always the intention that every HMRC inspector would have direct or indirect responsibility for ensuring the implementation of the minimum wage. When inspectors check whether VAT, tax or national insurance contributions have been paid, they also have the capacity to check on wage levels, and vice versa. HMRC does not have just a handful of individuals in a region with a particular skill, but a large number of people in each region of the United Kingdom, including Scotland, Wales and Northern Ireland, who can implement the minimum wage. It uses an army of people, rather than a small number of people within that army, to implement the minimum wage. However, it is worth considering whether it can utilise its resources more effectively.

Secondly, when vulnerable workers think of making a complaint, the first question that they ask themselves is, “What will happen to me?” Nine times out of 10, they are not in a trade union, and nine times out of 10, they are in a part of the economy where the trade unions are disorganised or not organised at all.

Thirdly, regardless of whether workers are married, unmarried or in a relationship of any sort, and regardless of whether they have responsibilities of any sort other than to themselves, we can be sure that their wage will be the only wage that they have.

May I make a point about the second issue that my right hon. Friend has raised? In many areas, such as my constituency, the vast majority of employees work in small companies and are often not entitled to join trade unions, because trade unions are not recognised. That is one of the changes that could be made.

No, that is okay. It is more than a fair point. The minimum wage was so important, because it was meant to help workers who could not organise to get a higher rate. We must ensure that we deal effectively with the barriers to making a complaint in the first place. We did that by treating the minimum wage as a day-one right, which could be claimed by the worker themselves or by someone representing them, which is important. In other legislation, we have tried to improve the capacity of unions to get into small and unorganised workplaces, but the unions still have a low base in the low-paid sector, although they are beginning to expand, speak up and speak out.

On a daily basis, the practical truth is that workers will still be on their own. That is why HMRC and the Gangmasters Licensing Authority are important. Now that we have established those bodies, we may have to look at ways to bring them together more effectively—in a single agency or whatever—so that they have the capacity to intervene immediately when an employee or group of employees makes a complaint about their wages.

It is important that those who decide not to pay up immediately in keeping with the regulations face a further penalty. Workers should be entitled not only to back pay, but to compensation. That is vital, given the trouble that people go to simply to claim the minimum wage. Few of them are in a trade union, so all communication—whether it is telephone calls or whatever—involves a cost to them. There is the cost to them in terms of worry and concern, and there is also the cost of trying to borrow money from somebody else when their employer does not pay them the wages to which they are entitled and which they need to meet their bills. They can be hard-working, but they can still be unable to meet their bills. So getting back the £300, £400 or even the thousands of pounds that people are owed is not enough; we need to see whether there should be a compensation package. I hope that the Government will consider introducing in the Bill the capacity not only to repay people where they have been underpaid, but to compensate them.

We could debate that issue and related issues for a long time, but I know that other colleagues want to come in. However, the fact that we are having a debate shows that we still have a Labour party in Parliament that remembers where it came from, where it is going and where it needs to get to in a disciplined fashion. The longer we keep the Government where they are, the more vulnerable workers will become less vulnerable and the more workers who are being underpaid will get the minimum wage. It is critical that that happens.

The publication of information on the minimum wage raises several key issues. First, few workers understand their rights. Secondly, few can calculate what their wage should be. Thirdly, in industries where workers are vulnerable, few of those who take up work get a contract of employment that is worth the name or which informs them of their rights. Fourthly, when workers get information, it is often confused or not adequate to help them assess whether they are getting the minimum wage.

The Low Pay Commission should, therefore, have a statutory right to amend the relevant regulations to ensure that we have a different form of payslip. Workers should be entitled to a basic minimum payslip designed by the Low Pay Commission. They should be able to use their first payslip to calculate whether they are receiving the minimum wage. On the back of that payslip, there should be information about the hotline and about where people can go if they believe that their employer has miscalculated their wages.

We should take responsibility away from the unions, the employer and the employee and put an easy reckoner on the payslip to show whether the minimum wage has been paid and, if not, how people can get back the money that has been stolen by their employer. If we were to take that step, we could help hundreds of thousands of workers a year.

It would be a mistake if we went to court in the end. I would rather see the money spent on investigations. I would rather put money back in people’s pockets than spend hundreds of thousands of pounds of scarce resources on taking employers to court, when they might just bunk off in the end—many of them would do that. We have to take measures to deal with this issue as part of a prevention strategy, rather than a strategy to deal with things once the horse has bolted.

We must improve the role of HMRC and its relationship with other agencies, such as the Gangmasters Licensing Authority. We must put resources into ensuring that workers understand their entitlements from day one, so that they know when they get their first pay packet whether they are being paid the minimum wage to which they are entitled.

It is a tradition to congratulate the hon. Member who secured the debate, and it is usually a formality, but my congratulations and thanks to my hon. Friend the Member for Edinburgh, North and Leith (Mark Lazarowicz) are genuine, because the debate is very timely. We think that the Second Reading of the Employment Bill will be towards the end of June, when the Government will have the opportunity to deal with the range of issues that we are covering. I associate myself, by the way, with what has been said about my right hon. Friend the Member for Makerfield (Mr. McCartney); we would not even be having this debate if it were not for his work.

The Employment Bill will enable us to consider the issues of tips, group actions and holiday pay. I hope that Mr. Speaker will allow us to address the issue of the exclusion of those under 21 from employment rights legislation. I want to raise something else, too. Several of us have been involved in the National Union of Rail, Maritime and Transport Workers campaign on minimum wages for seafarers. We have led a campaign for a decade now in which we have tried to demonstrate that seafarers working on UK-flagged ships are paid at different wage rates because of their race. The European Union intervened, and the Government introduced legislation so that those workers could not be discriminated against on the grounds of nationality. However, many of us thought, “What’s the difference?”, because employers will still get round the provision and avoid paying people a fair wage.

The concession that the Government made in the Select Committee on Regulatory Reform, which I attended, was that the minimum wage would be paid to all UK seafarers—all workers on UK-flagged ships—when they are in British waters. We thought we had a major victory, and we were about to put out a press release congratulating the Government—a rare thing for me—on their work. Then we got back to the office to discover that the change did not apply to British territorial waters, but to British internal waters, which means it concerns the Norfolk broads. Many routes from this country are not included in the provision, which has enabled shipping companies to avoid paying the minimum wage on a large number of UK-flagged ships, particularly ferries, which is a disgrace in this day and age. We shall table amendments to the Employment Bill.

I hope that we are setting the agenda for the Government, and that in three weeks—I hope it is three weeks—they will table amendments to address the anomalies that we have outlined. Also, I think that hon. Members have today constructively demonstrated how the system can be improved to achieve the original objectives that we all—certainly on the Labour Benches—supported when the minimum wage was proposed. I concur with the criticism about those who are under age, and so on, and we can deal with that in the Bill, if we are creative enough in drafting amendments.

Whatever improvements we get will be irrelevant, however, unless we have the resources to enforce the minimum wage. I chair the Public and Commercial Services Union parliamentary group, which is an all-party group. The union has welcomed the minimum wage, and it is PCS members who enforce it. They welcomed the statement in 2006 by the then Chancellor of the Exchequer about increasing resources by 50 per cent. and the statement by the Minister for Employment Relations and Postal Affairs that there had been a £3 million increase in the overall budget. Ministerial statements have been superb, but the delivery at management level has not reflected the political statements and commitments that we have been given. For example, the budget in question was frozen for a period before the additional money was made available—management froze it as part of an overall review of departmental resources. One of the statements made by Government was that there would be 20 additional compliance officers. First, none were in place by April 2007 and only 17 had been recruited by 2007-08.

We have been asking questions about where the £3 million has gone. The figures show that the HMRC budget devoted to national minimum wage enforcement in 2006 was £6.3 million, and that that went up to £6.7 million in 2007-08. Only £6.5 million was spent, which does not reflect a £3 million increase in resources. We have looked at the BERR budget with reference to promotional work, but it only accounts for an increase of £200,000. Again, it seems that because of managerial decisions made within the Department, the money that was awarded at the political level has been swallowed up elsewhere and has certainly not been applied to front-line staff to implement policies. In order to extract information, the unions have submitted freedom of information requests about the budgetary disbursement of resources.

The key issue is to use the opportunity presented by the Employment Bill to bring together the agenda of improvements, to put right the issues that we are concerned about and to continue the pressure to increase the minimum wage, now that, as my right hon. Friend the Member for Makerfield has said, we have established the principle and shot down all the arguments about the cost to jobs. However, we must, when we make policy here, make sure that the resources are available, and that they are well and consistently managed, to enable the policies to be carried out. In that matter, members of the PCS who are working on the front line are not confident that the management of resources will ensure that that policy is implemented, which is something that I am sure all Labour Members want.

Not just formally, but genuinely, I congratulate the hon. Member for Edinburgh, North and Leith (Mark Lazarowicz), on introducing an important subject through a combination of serious policy argument and some powerful anecdotes to support his case. He has been well supported by his colleagues—particularly the hon. Member for Linlithgow and East Falkirk (Michael Connarty), who had direct experience of low-paid work in his younger life, and the hon. Member for Hayes and Harlington (John McDonnell) and the right hon. Members for Oxford, East (Mr. Smith) and for Makerfield (Mr. McCartney), all of whom have been involved in the trade union movement.

The starting point of the speech by the hon. Member for Edinburgh, North and Leith was that the minimum wage has been a success—I think that that is right; it has been a success, despite great scepticism when it was introduced. I own up to being one of those who was somewhat sceptical about how it would work, but it has worked well because it is well designed and because it is supported by the independent Low Pay Commission. For that reason, certainly in the eight years for which I have been my party’s spokesman on Trade and Industry and then Treasury matters, I have been happy to support the national minimum wage and the upgrades to it.

We can see the products of the minimum wage’s success at several levels. One, although I know that the hon. Member for Linlithgow and East Falkirk is sceptical about it, is the clear evidence that for people at national minimum wage level there has been a much more substantial increase in earnings in the past eight years; I think the figure is 53 per cent. as against 40 per cent. with respect to average earnings. The differential, therefore, between people at the bottom and people in the middle has narrowed. Of course, there is the problem of the people at the top, but that is an argument for another day. Large numbers of workers are now less dependent on benefits—they earn a decent income, or at least a survivable one, based on their own labour. It has also been important—this was the issue on which much of the scepticism centred—that unemployment has not been a consequence of the minimum wage, as it was with badly designed systems in, for example, France. All those elements make a successful policy.

The debate, however, is about enforcement, and it is important to set out why an effective enforcement regime is important—it is obviously important for the workers concerned. The hon. Member for Edinburgh, North and Leith has mentioned that £27 million has been retrieved for workers who were being cheated out of their wages. The problem is increasing: as I understand the Government’s figures, the arrears on minimum wage cases now average £214 in the past financial year, as against £130 in the previous year. A lot of money is at stake for the people concerned.

Enforcement is also important for employers. We tend to forget that large numbers of employers, however reluctantly, comply with the law, and there is nothing worse than a competitor down the road who is cheating. It is for their sake, as well as for the workers’, that we need an effective enforcement regime.

That is an important factor in relation to compliance; businesses, small or otherwise, who have to compete in an open market do not want to be undercut by another employer either on wages or other conditions. That is why compliance is an issue not only for employees, but for maintaining the support of the employers who comply.

That is my point, which the right hon. Gentleman has made trenchantly and correctly.

Compliance is also of importance to the Government because, as the right hon. Member for Oxford, East has hinted, if many companies are not willing to comply with the law, including criminal sanctions on the minimum wage, they are probably not complying on many other matters. He has mentioned health and safety regulation in particular, but that applies to paying tax and complying with immigration rules. I understand that there is now an integrated enforcement system involving the former Department of Trade and Industry, Customs and Inland Revenue, and I should like to know whether there is a systematic way of looking at companies that are flagrantly in breach in terms of their overall compliance with the law. Is information pooled between Government agencies? It would be a much more effective deterrent to companies than a £200 fine, however necessary that is, to know that Government agencies will come down on them like a ton of bricks regarding their other obligations—in particular, tax. How effectively do agencies co-ordinate regarding companies that do not comply?

On enforcement, I want to ask about a particular issue. My hon. Friend the Member for Brent, East (Sarah Teather) has obtained information on the number of closed cases in which non-compliant companies had arrears. I think that the number was more than 14,000 cases for 2006-07, of which only three cases have been prosecuted. No cases have been prosecuted since the new system of inter-agency co-ordination was introduced in 2006. Why have there been only three prosecutions? It could be because the system is so brilliantly successful that the authorities have no need to enforce prosecutions, as everything has been done happily and voluntarily, but I suspect that there is a reluctance to bring prosecutions. Why have so few prosecutions ever been taken to the final stage?

The right hon. Member for Makerfield has said that the Government are coming forward with new powers under a Bill. We should discuss some of the ideas in that package, most of which seem very sensible. They include the proposed £200 statutory fine per worker for abuses of the regulation—that is a civil penalty—and a proposal, which has not been discussed yet, that workers who have lost their minimum wage entitlement should be compensated at current, and not historical, pay rates, which would make a substantial difference.

Another proposal from the right hon. Member for Makerfield, which the Government have not accepted, is that compensation should be paid. There has been some discussion about whether there should be interest payments on arrears, because otherwise employers are effectively obtaining interest-free loans from their workers. The trade union side has proposed that interest should be paid, which seems right in principle, and I am not sure why the Government are reluctant to accept that. I know that we are in a consultation process, but will the Minister say a little more on why the Government are so reluctant to go down that road?

My final point on enforcement illustrates some of the difficulties. I saw from a table that the Government produced in response to a parliamentary question that the number of enforcement officers in Wales is eight, which is the number in Northern Ireland, whereas the number for the whole of London is nine. There are seven times as many people in London, which also has a concentration of ethnic minority employees and employers, and it is unclear how the allocation of enforcement officers is decided. Is it decided by accident, or as a result of the difficulties of recruiting people in London? Perhaps the Government should focus on how effectively to allocate the scarce resources at their disposal to ensure that people who are deprived of the minimum wage can claim it.

It is a great pleasure to have you in the Chair, Dr. McCrea. I think that you also participated in the last debate that I attended in Westminster Hall, on HMRC matters. It is a pleasure to congratulate the hon. Member for Edinburgh, North and Leith (Mark Lazarowicz) on securing the debate, which has been useful and passionate at times, and which has helped to flush out one or two important issues.

Several hon. Members have mentioned the position of the Conservative party. We have supported the principle of the minimum wage for eight years, and the concerns that we had before its introduction were widely held. Indeed, the hon. Member for Twickenham (Dr. Cable) expressed some scepticism, as he has said. We were concerned that a minimum wage set at a high level would endanger jobs. It is difficult to argue against the proposition that the minimum wage endangers jobs at some point, but the independent Low Pay Commission has been successful in balancing those dangers against the ability to increase pay for low-paid workers.

The hon. Member for Linlithgow and East Falkirk (Michael Connarty) argued for a substantial increase in the minimum wage. If he were still in his seat, I would suggest to him that there would be difficulties in doing that. None the less, recognising the principle behind the minimum wage, the fact that the legislation exists is, in itself, a reason why it should be enforced. People should abide by the law as a matter of course, but it does benefit employees whose wages have increased.

I am pleased that the hon. Member for Twickenham raised an issue that I was going to raise. Enforcement and compliance with the law are important for employers who abide by the law, who would be undercut and faced with unfair competition if rogue employers were flouting the law and were therefore able to undercut those other employers. That is an important issue. The Conservatives support calls for effective enforcement of the existing national minimum wage.

We have heard that there have been few prosecutions regarding the national minimum wage. I expect that the Minister will say, by way of explanation, that when employers are found not to have complied with the national minimum wage, they rectify the position and pay money in arrears, so there is no need for prosecution. Today is not the day to debate the detail of the Employment Bill, which the hon. Member for Hayes and Harlington (John McDonnell) has mentioned. The Minister and I have just spent the best part of two days debating HMRC’s powers more generally and we have not finished yet, so I do not want to go through a detailed analysis of the proposals that might be in the Employment Bill. However, I ask the Minister to consider whether the low number of prosecutions is in any way due to HMRC’s lack of power to enforce the national minimum wage.

There are other indications that there might be problems. We have heard about the level of arrears, and we have statistics from the Office for National Statistics on the number of people who are not receiving the national minimum wage. To what extent does the Minister think that the absence of adequate powers at HMRC has caused the problem? Has it been more to do with HMRC’s resources?

I shall not speak at length about the problems that HMRC faces—we debate them fairly regularly—but clearly there are issues of low morale in HMRC. It faces very challenging budgets and, as a whole, it is suffering from a tightening of the belt. We heard reference to the increased expenditure announced in the 2006 pre-Budget report for tackling failure to comply with the national minimum wage, but to what extent has that aspect of HMRC’s expenditure been immune from any Gershon savings, or is it not possible to analyse it in that way? To what extent has the expenditure been ring-fenced, and have the pressures that undoubtedly have been felt in HMRC in general also been felt with regard to enforcing the national minimum wage?

We should not consider the HMRC issue in isolation. Whether in this Room or elsewhere, we have debated VAT repayments, tax credits and other important issues, in respect of which there is serious concern about HMRC’s performance. One reason why I am grateful to the hon. Member for Edinburgh, North and Leith is that he has highlighted this issue as needing to be addressed.

I seek from the Minister more information on the difficulties in enforcing the minimum wage. For example, have any particular groups been affected? Other hon. Members mentioned migrant workers. Anecdotally, we often hear about eastern Europeans doing agricultural work who are being exploited. My hon. Friend the Member for Shrewsbury and Atcham (Daniel Kawczynski) would not want me to highlight eastern European migrant workers in particular. I am referring to migrant workers from throughout the world. Are particular sectors, locations or migrant groups especially affected?

I would be grateful if the Minister touched on an issue that “Panorama” highlighted—accommodation or transport costs being deducted from the wages of migrant workers in particular. The employers are apparently complying with the national minimum wage, but in reality what ends up in the pockets of the workers is substantially below it. Can the Minister provide guidance on that?

I return to the rate of the national minimum wage. As I have said, the Low Pay Commission has worked well, partly because of its independence. It takes representations and then makes an assessment of the level of the minimum wage. However, we saw in the debate about the 10p rate of income tax that one proposal that was clearly considered by the Government was using the minimum wage as a way of trying to compensate those who had lost out as a consequence of the Government’s policy. That would appear to be an interference with the way in which the Low Pay Commission works. It would appear to be the Government setting the agenda or giving instructions to the commission, which would be a departure from previous practice.

I cannot help but observe that the trade unions, entirely understandably—this is part of their role—are very strong in calling for substantial increases in the national minimum wage, and the influence of the trade unions on the Labour Government appears to be increasing. I think that 92 per cent. of the funding for the Labour party now comes from trade unions. Therefore, to respond to demands from the trade unions, will the Government put pressure on the Low Pay Commission to increase the national minimum wage above the level that would otherwise be determined?

I was getting a bit lost at the end of the hon. Gentleman’s argument. Can he provide clarification? Is his party committed to continuing the above-inflation increases—minimum wage though it is—that the Government are putting forward? Is his party in favour of that, or is it moving towards a position from which that will be taken away?

We have no particular desire to change the system. We believe that, over 10 years, the Low Pay Commission has acted in a responsible manner that has not endangered jobs and has benefited low-paid workers. We have no particular desire to change that. I am merely pressing the Government on whether there will be any change in their policy—today of all days, the Government are listening to their Back Benchers—whether it be with regard to the Employment Bill or a range of other matters. I would be grateful if the Minister responded on that point. To conclude, enforcement is important. Particularly at a time of rising fuel bills, food bills and taxes, the national minimum wage should be enforced properly.

It is a pleasure to serve under your chairmanship, Dr. McCrea. I do recall the occasion on which we were discussing issues close to your heart. I am sure that we will return to those—perhaps not in an Adjournment debate but certainly in other exchanges.

I congratulate my hon. Friend the Member for Edinburgh, North and Leith (Mark Lazarowicz) on securing the debate; I genuinely mean that. I agree that it is a very important debate. I have been studying with a lot of interest the answers that I have been invited to give to questions, and asking of HMRC many of the questions that have been asked in this Chamber today. Before I give detailed responses to the questions that I have been asked, I just want to say that although my hon. Friend the Member for Telford (David Wright) sits silently through hours of debate in proceedings on the Finance Bill, he did say that he had had a discussion with our hon. Friend the Member for Dudley, North (Mr. Austin) about low pay and the national minimum wage and they recalled an advert from the Express & Star, which I understand is a newspaper that is widely read in the midlands. The advert, from the early 1990s, was for a security guard and it said:

“It’s £2 an hour and bring your own dog.”

I make that point to show how far we have come since employment conditions were of that nature.

I endorse everything that was said about the role that my right hon. Friend the Member for Makerfield (Mr. McCartney) played in taking the National Minimum Wage Bill through the House of Commons. My right hon. Friend the Member for Oxford, East (Mr. Smith) also played a role, as indeed we all did in bringing in that legislation. I have been in politics a long time and I recall when I was a member of the National Union of Public Employees and we and the Union of Shop, Distributive and Allied Workers were in splendid isolation in the TUC in support of a national minimum wage, so from the early 1980s onwards this cause has been dear to my heart. I am delighted that we are here today, asking questions. I am rightly being scrutinised about the implementation and enforcement of this very important measure.

The national minimum wage benefits millions of workers, as has been said. The increase in the rates every year benefits more than 1 million people, who see their pay increase as a direct result of the increase in the national minimum wage. I am pleased, but not surprised, that despite the dire predictions of 10 years ago, the minimum wage has become an accepted feature of our labour market and is supported by the majority of employers. That is a welcome sea change in attitude.

Of course, the success of the minimum wage is not just about the fact of it or its level; it depends largely on effective enforcement, as non-compliance undermines its objective—a point that the hon. Members for Twickenham (Dr. Cable) and for South-West Hertfordshire (Mr. Gauke) reinforced. The objective of the minimum wage is to enable workers to see real benefits from their labour in their wage packets. That is why we introduced it, and it is important, therefore, that compliance be policed effectively and non-compliance dealt with rigorously.

Since the national minimum wage was introduced in 1999, HMRC has identified more than 4,000 employers, and compliance teams found compliance in only 1,649 of those cases. I beg your pardon, Dr. McCrea, that was wrong; I shall put it right for the record. HMRC has identified more than £30 million in wage arrears since 1999. Last year alone, more than 4,000 employers were looked at. I am glad that I spotted my mistake; it was a major understatement of HMRC’s work. HMRC found non-compliance in 1,649 of those cases, which represents nearly £3.9 million in arrears for more than 19,000 workers. HMRC is identifying non-compliance and punishing it, but I realise that there is more to do. That is why the funding available for enforcement has been increased. My hon. Friend the Member for North-West Leicestershire (David Taylor), who is not in his place—I see that he is speaking in the main Chamber—spoke of the 50 per cent. increase in resources over four years.

It is important that I outline HMRC’s approach to enforcement and respond to a number of issues raised during the debate. We have heard that enforcement is based on 16 regional compliance teams. There is also a helpline, based in the north-east, that workers or third parties can call. Employers who might not be paying the minimum wage are generally identified through complaints to the helpline or through risk assessments. Last year, the helpline received more than 46,000 calls, of which more than 2,800 were complaints about possible underpayment.

The compliance teams have a range of strategies for dealing with enforcement. They also use an approach of targeted enforcement, focusing on sectors in which non-compliance is likely. I was asked to illustrate what sectors they might be. It is not only migrant workers who are exploited; other sectors, too, are at a high risk. In recent years, they have included hairdressing—we keep returning to that—child care and the hotel sector. HMRC will raise awareness in those sectors by providing information to workers and ensuring that employers know what they should do to comply. HMRC also investigates a number of employers from the chosen sector in order to check that the risk assessment remains appropriate.

My hon. Friend the Member for Edinburgh, North and Leith asked why it takes so long to pursue cases and whether that is caused by a lack of resources. I asked HMRC whether the resources that it applies to enforcement are sufficient, and I was advised that they are. The way in which HMRC allocates resources for national minimum wage enforcement is constantly kept under review.

I am sure that that is what my right hon. Friend has been told. All that I can say is that my constituent was told by the person to whom she spoke that there was big backlog. Perhaps that member of staff had a particular problem, but from what I have picked up anecdotally I suspect that it was not a one-off case. There is evidence of a heavy work load, and I ask my right hon. Friend to look again at ways of assessing whether the resources are equal to the work load and to the demand for the service.

One of the benefits of debates such as this is that I can assure the House that I shall test the advice that I have been given. I undertake to do so.

We heard that in the 2006 pre-Budget report the then Chancellor, now my right hon. Friend the Prime Minister, announced an increase of £2.9 million a year for enforcement. The focus of HMRC’s campaigns is raising awareness of the national minimum wage and the current rates in order to ensure that workers and employers know where to go for advice or to make a complaint about possible non-payment. An outreach bus has visited more than 60 locations over nine weeks. It reached more than 700,000 workers directly, and the outreach team handed out more than 130,000 leaflets and spoke to almost 90,000 people. The outreach bus route was planned to enable HMRC to reach as many of those who needed to know about the minimum wage as it could, based on what it knows about the areas of risk. Calls to the helpline that required translation increased during that campaign by more than 400 per cent.

The Minister has partly answered my question. From reports, the outreach service was met more favourably in some localities than others. Was that generation of additional work so significant that the Department believes that it would be a good idea to repeat the process?

HMRC regards its awareness-raising role as a significant part of enforcing the national minimum wage.

I want to share with the House an important part of the National Association of Citizens Advice Bureaux report entitled “Rooting out the Rogues”, which was published on 30 November. Hon. Members may be aware of it. NACAB said:

“we have repeatedly suggested that there needs to be an alternative way of tackling the exploitation of vulnerable workers by unscrupulous or ‘rogue’ employers—one that does not rely on individual workers entering into a stressful, costly and potentially damaging legal confrontation with their employer”.

It went on to state:

“we have argued that the more proactive enforcement regime associated with the National Minimum Wage—one based on carefully targeted inspections of suspect employers by HMRC, as well as on the investigation of individual, anonymous and third party complaints—should be extended to cover all basic statutory workplace rights.”

We established our largely inspection-based approach precisely because we did not want workers to have to rely on the approach referred to—doing exactly what the constituent of my hon. Friend the Member for Edinburgh, North and Leith did, and putting themselves at risk by taking action against the employer. I was pleased to see NACAB’s endorsement of our approach.

There is never enough time, Dr. McCrea, in debates of this nature to deal with all the points that hon. Members raise. There are well over 1 million employers in the UK. One can see from the figures that the vast majority comply, seeking to treat their employees fairly and properly. Changing HMRC’s risk-based approach to one in which it regularly visits each employer—as suggested by my hon. Friend the Member for Luton, North (Kelvin Hopkins)—would divert resources away from those most likely to be non-compliant. HMRC is right to believe that that would not be an effective method of improving minimum wage enforcement.

My right hon. Friend the Member for Makerfield and the hon. Member for Twickenham asked about HMRC’s dedicated enforcement teams. Those teams work closely with their tax, national insurance, VAT and Customs colleagues. Information is appropriately shared, given the debate about protection of information; but when necessary, it is shared. Indeed, a number of risk-assessed cases are initially identified by other staff in HMRC—for instance, by those involved in pay-as-you-earn taxation or tax credit information.

I am running out of time, Dr. McCrae, and there are many other points that I wish to address. With permission, I shall do so in writing. On occasion, we are in danger of talking down the success of the national minimum wage and the good work done by HMRC. I commend the officers of HMRC, who take their enforcement role seriously and take their work forward very thoroughly.

Tattooing and Skin Piercing

The number of people undertaking a tattoo or body piercing is increasing year on year. Ears, tongues, lips, eyebrows, navels and sexual organs are now routinely pierced. More extreme body modifications, such as the creation of patterned scars and the insertion of items such as ball bearings under skin, are also taking place.

High standards of cleanliness and disease control are of the utmost importance in piercing and tattooing. One mistake can have consequences both severe and permanent. Blood-borne infections such as HIV and the more dangerous hepatitis B and C, pain, severe scarring and even death can result. Many working in the industry are increasingly concerned that legislation and regulation have not evolved to cover the ethical and medical problems that need to be addressed.

In preparation for this debate, discussions have taken place with a range of local authorities in England and Wales, with professional tattooists and piercers and with Professor Noah at the department of epidemiology and population health at the London School of Hygiene and Tropical Medicine, all of whom want the industry to be better regulated to protect the public as well as the livelihoods and reputations of professional tattooists and body piercers. I was asked initially to look into the need for improved regulation and standards in the field by the union GMB, whose members include a small group of tattooists and piercers. I was joined in carrying out research among local authorities by my hon. Friend the Member for Northampton, North (Ms Keeble), whose support and interest in the issue I wish to put on record.

Local authorities outside London have powers to regulate acupuncturists and businesses providing tattooing, semi-permanent skin colouring, cosmetic piercing and electrolysis under the Local Government (Miscellaneous Provisions) Act 1982 as amended by the Local Government Act 2003. The legislation provides for the registration of practitioners and premises and the observance of byelaws relating to the hygiene and cleanliness of the practitioner, premises and equipment used.

In September 2007, the Department of Health issued a combined set of model byelaws for local authorities covering cosmetic piercing and semi-permanent skin colouring businesses. However, the speed at which changes take place in the industry means that as soon as I began my research, the vast majority of local authorities to which I spoke called for greater strength and scope in the model byelaws. Although local authorities acknowledge that they can develop individual interpretations of the model byelaws and their own unique way of doing things, and although I found some truly excellent practice with very high standards, in other areas such standards were not in place. The result is a postcode lottery of public protection. Similar comments were made about byelaws issued by the devolved Administrations.

Most local authorities have some system of registering tattooing and piercing businesses. The exact nature of that system varies from area to area. There is no nationally agreed standard for inspection. Consequently, some authorities carry out tougher inspection and licensing regimes than others. For example, Cardiff city council’s licensing system involves prior operating approval before a licence is granted. Then, depending on their assessed risk rating, premises receive a proactive inspection under the provisions of the Health and Safety at Work, etc. Act 1974. Premises receive an annual re-licensing and health and safety visit, but other authorities have much simpler registration systems with no conditions attached other than compliance with byelaws.

Common consensus agrees that the guidance in the model byelaws is not detailed enough. More precise guidance was called for to cover types and storage of equipment, the use of disinfectants and anaesthetics, age limits, consent forms and aftercare advice. Those involved in piercing sexual organs are unable to provide anaesthetics. I am advised by Professor Noah that surface applied anaesthetics that freeze the area are more likely to cause pain than to prevent it. The risk of infection after piercing increases with moisture, friction or lower levels of cleanliness, all of which apply to intimate body parts.

There are calls for clarity about sterilisation equipment and which chemicals should be used to clean premises. Many call for needles to be single use only and for autoclaves to be made compulsory. I was advised by Professor Noah that, despite the wide range of chemicals available, using bleach to clean studios and 70 per cent. alcohol to clean piercings or tattoos, as well as basic hand washing by practitioners, should be standard requirements.

Given the popularity of tattooing and piercing, there is a worrying lack of public awareness of the potential risks involved in those procedures. Practitioners have no legal obligation to advise people of possible risks or side effects, check medical histories or give appropriate advice on aftercare. Scarring after infection of a pierced area can be dramatic.

The hon. Member for Sheffield, Heeley (Meg Munn) has worked with Dan Aid on the issue of checking medical histories. Christina Anderson, an inspiring woman, set up Dan Aid after her son Daniel died of septicaemia after having a lip piercing at age 17. Daniel had a severe heart condition that put him at increased risk of developing complications. He was not told of the risks and therefore denied the opportunity for informed consent.

To protect both practitioners and clients, before every tattoo or piercing, the piercer or tattoo artist should take the time to sit down with the client and run through a detailed checklist covering medical history and potential infection risks. The client should be required to sign confirmation that they have been given advice and a leaflet with advice about aftercare. The process would help to protect clients and practitioners because, when a piercing becomes infected, people often complain but do not remember being given aftercare advice. Records should be kept of the procedures carried out and the advice provided. Aftercare advice is important to avoid bacterial infection, especially in the cartilage in the ear, which is difficult to treat with antibiotics. Simple advice about not removing scabs or using 5 per cent. alcohol solutions as disinfectant is needed, as wetting wounds with 5 per cent. alcohol increases the chances of infection.

We do not ask our doctors and nurses for their qualifications when they treat us; we take it for granted that they cannot practise without the qualifications and skills needed. Yet those who carry out tattooing and body piercing do so without needing a minimum qualification. When a tattooing or piercing business is registered, inspections are made of the equipment and the standard of the premises, but there is no way to assess practitioners’ competence. That is worrying, because the growth in popularity of tattooing and piercing and the more extreme piercings and so-called body modifications means that more untrained and inexperienced people are entering a trade where high profits can be made, especially from more extreme piercing and body modifications.

At the inquest for her son Daniel, Christina Anderson was informed that in having his lip pierced, he had had a minor operation. People are unknowingly submitting themselves to minor operations, sometimes in back rooms, and local authorities have no idea whether a practitioner is competent to carry out such procedures. All piercings are regulated in the same way; at the moment, there is no gradation of piercing. Anyone who pierces ears can pierce anywhere else on the body.

Opinions vary as to the best method of ensuring that people are adequately qualified. Consultation is needed, but options include a recognised college course of one or two years or apprenticeship for a similar period. Both those methods of training would need to include aspects of anatomy, hygiene, disease control, the operation of equipment, health care and significant practical components.

There is no statutory age limit for piercing, and intimate piercings can be carried out at any age. Under sexual offences legislation, genital, navel or nipple piercings on someone under 16 might be regarded as indecent assault, but I found no evidence of prosecutions. We know that such piercings have taken place without parental consent or involvement, some of which have become infected and needed serious medical intervention to protect the life of the young person. I fear, therefore, that there is a lack of protection for minors. Local authorities have complained that, in reality, the most that they can do is revoke the licence of a person who has carried out such a piercing. Tattooing a butterfly on to the arm of a 13-year-old is illegal, but piercing the same person in a genital area is not. That cannot be right. It is time for us to set legally enforceable age limits on any piercing other than of the earlobe.

So far, I have talked about tattooing and piercing parlours, but home-based piercing and tattooing is an emerging problem. The sale of equipment over the internet to unregistered persons and premises is fuelling this problem, as increasing profits are to be made. I am advised that social networking sites carry contacts for unregistered tattooists and piercers selling their services, and legislation is needed to bring such home-based practitioners into the registration system. It is incredible to think so, but home-based piercing parties take place in some communities involving people with no training, qualifications or skills.

Both practitioners and regulators have called for stronger, clearer, more detailed and more precise guidance and byelaws, and many experts and professionals would be more than happy to engage with the process. I understand that Graham Martin and the Tattooing and Piercing Industry Union’s working group have already done much of the necessary work and produced their own model byelaws based on modifications of the Scottish Parliament’s model. That would enable best practice to be rolled out across the UK and provide valuable support to environmental health departments that already do so much good work ensuring public safety.

A national system of licensing is required. Byelaws should specify which type of equipment is acceptable for use and give advice on chemicals and local anaesthetics. They should also include an obligation to ascertain the age and medical history, a consent form and information and obtain on the potential risks associated with any procedures and give accurate aftercare advice. As already stated, such changes could be potentially life saving.

I have commented already on the need for qualifications for those carrying out such interventions. An age limit must be introduced for body piercing with the more intimate and extreme piercings reserved for over-18s, which would give local authorities greater power to protect minors. Everyone would benefit from tightening regulation in this area. The public would be protected as would the excellent and reputable tattoo artists and body piercers who want to see their industry and their livelihoods protected.

I am aware that Professor Noah, and some of his colleagues from the Health Protection Agency, have produced a paper on the hazards of body piercing, based on a survey, which will be published in the British Medical Journal very soon. I urge my hon. Friend the Minister to ensure that that is read and considered by the Department of Health so that we can begin to move forward and provide the level of protection so urgently required for those individuals. Many of us in this House might not understand the motivation for wanting some of the more extreme body piercings and tattoos, but in undertaking such practices, people should be protected by the law as are those going into hospital for minor surgery.

I congratulate my hon. Friend the Member for Bridgend (Mrs. Moon) on her success in securing this debate and apologise for the fact that I am substituting for the Minister with responsibility for public health, my right hon. Friend the Member for Bristol, South (Dawn Primarolo), who is detained by her responsibilities during the Committee stage of the Human Fertilisation and Embryology Bill. I am also grateful to my hon. Friend for setting out her views on the dangers of tattooing and other types of skin piercing, and on the regulatory framework. As she indicated, tattooing or skin piercing carried out incorrectly and in an unhygienic manner can result in a variety of problems, such as local wound infections or serious blood-borne viral infections such as hepatitis B, hepatitis C or even HIV. However, most complications are minor and self-limiting, such as local, minor wound infections that might not be caused by the piercing procedure itself.

As far as we know, serious complications are uncommon according to peer-reviewed literature, but none the less it is important that we have measures in place to ensure public protection, as my hon. Friend said. We have a legislative framework in place and, under the Local Government (Miscellaneous Provisions) Act 1982, local authorities have powers to regulate the practice not only of piercing, but acupuncture, tattooing and other cosmetic activities. In 2003, we strengthened the Act by giving local authorities powers to regulate body piercing and semi-permanent skin-colouring businesses. That legislation provides for local authorities to require the registration of practitioners and premises offering such services, and to introduce local byelaws relating to hygiene and cleanliness.

Local authorities inspect businesses under that legislation, usually based on a local risk assessment, and it is an offence to provide these services without being registered with the local authority or to breach local byelaws. As my hon. Friend will know, in London, the legislative framework is different in that local authorities have chosen to use private legislation to regulate businesses by licensing and inspection. Under licensing provisions in London, local authorities may set conditions under which a licence is granted to cosmetic body-piercing businesses. Again, offences are connected with non-compliance.

In addition, local authorities can use general enforcement powers under health and safety at work legislation, which provides useful flexibility and added protection for the public. That legislation enables local authorities to use improvement and prohibition notices, and ultimately to prosecute cosmetic body piercing businesses, if they judge that there is a risk to customers’ health and safety. Health and safety at work legislation will also apply to other procedures such as scarification and beading.

All that legislation of course applies to people offering tattooing and skin piercing for gain from their homes, not just in commercial premises. In 2007, the Department published an updated model byelaw, which has been well received by local authorities according to the feedback received. For example, Mid Sussex district council recently introduced updated model byelaws provided by the Department to assist local authorities, and stated:

“The new byelaws are good news for the people of Mid Sussex because they give environmental health officers the powers they need to protect public health.”

We have not received representations from local authorities or practitioners about the effectiveness of the current legislative framework.

My hon. Friend suggested that the byelaws should be more detailed, but they do provide a framework for hygienic practice, and we believe that details of hygienic practice and other matters are better covered in guidance by the Health and Safety Executive on enforcement in respect of skin-piercing activities. The guidance covers the issues that she raised, such as pre-consultation with the client, infection control, cleaning, disinfection and sterilisation, aftercare advice, anaesthetics and enforcement.

As my hon. Friend mentioned, the Department has funded new research by the HPA, which has investigated the prevalence and types of body piercing in those aged 16 and over in England and has estimated the proportion of piercings that result in health complications and the proportion of piercings that result in professional help and advice being sought. As she rightly said, that report is due to be published this Friday. However, after she secured this debate, I asked to see some of its draft findings, and without pre-empting too many of its conclusions, I thought that I would give her a foretaste, given her interest in the matter.

Some of the findings are interesting. The prevalence of cosmetic body piercing, excluding earlobes, but including the upper ear cartilage, in adults aged 16 and over is 10 per cent. Body piercing was more common among women than men and among younger age groups. Nearly half the women aged between 16 and 24 who were surveyed reported having had piercings. Some 33 per cent. of piercings were at the navel, followed by 19 per cent. at the nose, 13 per cent. at the ear, 9 per cent. at the tongue, 9 per cent. at the nipple, 8 per cent. at the eyebrow, 4 per cent. at the lip, 2 per cent. at the genitals and 3 per cent. at some other part of the body.

My hon. Friend may also be interested to know that the anatomical sites used for piercings varied by gender. Among women, the most common piercings were, in order, of the navel, the nose, the ear, the tongue, the eyebrow, the nipple and the lip. Among men, they were the nipple, the eyebrow, the ear, the tongue, the nose, the lip and the genitals. Thus, nipple piercing was the most popular among men but one of the least popular among women, and navel piercing was by far the most popular among women, accounting for more than a third of piercings, and much rarer among men. Some of the findings surprised me, and I am sure that they will surprise a lot of hon. Members and members of the public who, like me, are not au fait with the world of body piercing. “Ouch”, I said to myself as I read through a lot of that list.

My hon. Friend will also be interested to know that, overall, about 25 per cent. of those pierced reported complications. Among those aged 16 to 24, about 30 per cent. reported complications with piercings and 15 per cent. sought professional help, for example from pharmacists, piercers themselves or GPs. Piercing was much more common in that age group and more likely to have been done in recent years. The most common complications were local infections and bleeding, but serious complications requiring a hospital admission, for example, were extremely rare, at less than 1 per cent. We believe that the research will show that we probably need to do more work to determine the risk of complications and how best they may be avoided.

My hon. Friend expressed her concern about the fact that children can have body piercing done without parental consent, both from the point of view of whether it is appropriate and because of the possible health risks. I emphasise to her that Government policy on the age of consent is the responsibility of the Ministry of Justice, but she will know that the tattooing of minors is controlled by specific legislation. We think that that is appropriate, because of the permanent skin alteration that it involves. However, the piercing of ears and other parts of the body for decorative or cosmetic purposes is lawful. We have taken that judgment because we believe that cosmetic piercing is usually naturally reversible if jewellery is permanently removed from the piercing. There is no statutory minimum age of consent for body piercing or ear piercing. Minors can give valid consent if they are capable of understanding the nature of the act to be carried out. The degree of competence that can be exercised by children depends on the relative maturity of the child concerned as well as upon his or her age.

I understand that some parents feel concerned when their children have body piercing done without their consent. As with many such matters, a lot of the issues involved should be resolved within the family. However, I am advised that it is generally considered good practice by local authorities and by the industry for cosmetic piercing not to be carried out on minors without parental consent. If local authorities receive complaints from parents that that has been done by a particular practitioner, it is open to them to take action using their existing powers. The Health and Safety Executive guidance includes advice on encouraging businesses to adopt a reasonable approach to age of consent issues. Taking a reasonable stance on the age of consent avoids conflict with parents and enhances the reputation of the business. I would helpfully suggest that it also ensures that a business does not run into difficulties with the local authority, which has the responsibilities that I have described.

I am aware that this is a sensitive matter that concerns parents. However, we are concerned that if we introduced a statutory minimum age of consent, we could end up increasing the health risks of cosmetic piercing. Children might be tempted to try to pierce themselves or each other in an unsafe or unhygienic way, or to go to disreputable practitioners. We receive occasional representations on the subject and, as on all matters, keep our policy position under review.

I reassure my hon. Friend that we have a robust legislative framework that provides for local regulation of tattooing and skin piercing businesses. Centrally, the Department assists by providing model byelaws that local authorities can use.

My hon. Friend the Minister has not addressed the issue of qualifications and competency to practice. Will he comment on that in the remaining few minutes and suggest whether the Department has any concerns about it?

We are aware of the concerns, and although there are currently no formally recognised qualifications or training courses for body piercing, that is partly because the Government-funded project to develop such standards, of which my hon. Friend may be aware, ended prematurely because of opposition from the industry. We believe that it could have led to the development of formal qualifications.

We believe that progress can most quickly and effectively be made by practitioners, their organisations, industry bodies, training bodies and enforcement authorities working together to agree on suitable standards of good practice and competency. That is the best way forward, rather than our imposing statutory training requirements on the industry.

As I have explained, we recognise that there is concern about the lack of a statutory age of consent for cosmetic piercing, about some of the training standards and about how some local authorities are using our new model byelaws. We keep those matters under careful review and consideration, but we are not persuaded that a statutory age of consent would help. Our concern is that it might have the opposite effect.

Treasury Aims (Quality of Life)

I am delighted to introduce the debate.

I have a vivid memory of one of the first economics lectures that I attended during my time at the London School of Economics. The lecturer, the excellent Morris Perlman, who is sadly no longer with us, made clear to the undergraduates right at the beginning the distinction between money and wealth. “Money is pieces of paper or numbers”, he said, “but the wealth that you have is the sum of all the things that you value—both the things with a monetary value attached, like your home and possessions, and the things without a price tag, such as relationships, a feeling of security and your health.”

It is not just economists. Philosophers, too, contribute to the debate about what we really value. Earlier this year, A. C. Grayling said:

“Happiness is the measure of true wealth”.

I shall explore how we can measure that wider definition of the nation’s wealth and the implications that it has for policy making. I shall argue that levels of happiness are important, useful and integral to the concept of quality of life, as other Governments around the world, and even Departments other than the Treasury, acknowledge. I shall argue that happiness can be measured reliably and robustly and that the Treasury can and should do practical things to improve the nation’s happiness and quality of life.

The Treasury’s stated aim is:

“To raise the rate of sustainable growth, and achieve rising prosperity and a better quality of life, with economic and employment opportunities for all.”

I commend the Treasury for including a better quality of life in its aim, but I question whether that is taken as seriously as the growth and prosperity aims. Without quality of life being taken into consideration, growth is meaningless. Gross domestic product grows after natural disasters or oil spills, as the clean-up operation is costly, but it obviously does not follow that such events are desirable. If GDP growth comes as a result of our working longer hours, we may find our quality of life negatively affected. A Department of Trade and Industry study in 2004 found that 87 per cent. of employees said that they would like to spend more time with friends and family. If some of those employees were to cut their working hours to see their family more, GDP would fall. Would that be a bad thing, if that decision enhanced their quality of life?

Research clearly shows that our quality of life is not getting better. The world values survey tells us that, if anything, we as a nation are less happy now than we were in the early 1980s. We can go back further using polling evidence from Gallup, which shows that despite increases in GDP, we are less happy even than in the 1950s. Back in 1968, the late Robert Kennedy said in a famous speech:

“There is more to life than GDP.”

The debate about the best way for societies to measure progress has continued ever since. The blinkered pursuit of GDP growth on its own can lead to perverse decisions. We should recognise the limitations of pursuing GDP growth and introduce other measures to capture quality of life.

This idea is gaining momentum. Last week, Ipsos MORI dedicated its summer conference to the subject, under the title, “Who’s Happy Now?” Governments around the world are looking seriously at going beyond GDP, and not just the Government in Bhutan. Earlier this year the French President, Nicolas Sarkozy, commissioned two eminent economists, Joseph Stiglitz and Amartya Sen, to develop alternative measures of progress to GDP that would better reflect people’s well-being. Forty-eight Members from both sides of the House have signed my early-day motion 731, acknowledging static levels of happiness and the need for the Government to measure and address that. The British public agree. In 2006, a BBC-commissioned GfK NOP poll found that 81 per cent. of the British public think that the Government’s prime objective should be happiness and not wealth.

As I have mentioned, other Departments are also addressing this issue. In 2002, the Cabinet Office commissioned a paper on the subject, “Life Satisfaction: the state of knowledge and implications for government”. Although it was not a statement of policy, the paper declared that:

“There is a case for state intervention to boost life satisfaction due mainly to evidence of direct impacts on life satisfaction of government activities, together with strong evidence of the dependence of individuals’ wellbeing on the actions of others.”

The paper suggested a range of actions that the Government could take, including at the top of the list:

“the use of life satisfaction data to construct quality of life indices”.

Following the 2007 UNICEF study of 20 developed nations, in which children in the UK ranked lowest in terms of happiness and well-being, the Department for Children, Schools and Families has introduced “SEAL classes”, or so-called “happiness lessons”, in schools. The Department for Communities and Local Government has included subjective well-being measures in its new 2008 national indicators set, which will be used by local authorities to keep track of progress. It is also supporting the Local Wellbeing Project, which is being conducted by the Young Foundation to test practical interventions to improve people’s happiness in three local authority areas in the UK. The Department for Environment, Food and Rural Affairs has started to measure “life satisfaction” as part of its sustainable development indicators, and it has commissioned a sizeable body of research that highlights ways in which Government action could impact on happiness.

I very much welcome these moves. Many Departments are beginning to take the issue seriously. However, to bring all those activities together and co-ordinate what will otherwise be piecemeal efforts, the Treasury needs to take a lead. Sadly, when I raised this subject with the Chancellor in November 2007, while he waxed lyrical about growth and prosperity, he seemed less than serious when he said:

“I am willing to consider a Liberal Democrat happiness index”.—[Official Report, 29 November 2007; Vol. 468, c. 428.]

I hope that I am wrong, and that the Treasury has an open mind about creating robust measures of quality of life.

If the Treasury is to consider measuring quality of life, quality of life obviously needs to be defined. On 22 February, I asked the Chancellor what definition the Treasury is using, and I received this answer from the Financial Secretary to the Treasury:

“Productivity and employment are the key determinants of growth and therefore of living standards. However, a large volume of other data are also important indicators for a broader measure of quality of life, such as those on crime, working hours, social capital, social demography and health.”—[Official Report, 22 February 2008; Vol. 472, c. 1117W.]

That answer rightly recognises that living standards are not the same as quality of life.

Living standards have certainly increased in recent decades but, as I have said already, quality of life has not. The factors that were listed—

“crime, working hours, social capital…health”—

and so on are all important to quality of life, but with such a vague definition, it is not clear how the Treasury can measure overall progress towards its aim of a better quality of life. The answer also misses out how quality of life should be defined—the answer is by asking people. Measuring the subjective well-being of individuals is essential, if we are to know how the quality of life is changing. Asserting that quality of life has increased on a range of sterile indicators is not much use if people do not feel any happier or more satisfied.

Some would argue that happiness cannot be studied or measured accurately. However, science tells us otherwise. Lord Layard, the well respected Labour peer, goes over the evidence that it can be measured at some length in his 2005 book, “Happiness: Lessons from a New Science”. He is clear that the answers that an individual gives to subjective well-being questions not only match the answers that friends or independent observers would give about their well-being, but also correlate with scans indicating activity in corresponding parts of the brain.

Furthermore, the Government’s own sources suggest that a life satisfaction question is both robust and useful. A DEFRA paper published last year, “Sustainable development indicators in your pocket”, states:

“The independent research commissioned by DEFRA concluded that life satisfaction measures should provide reliable information about wellbeing in a policy context.”

Of course, just asking people how satisfied or happy they are may be interesting, but it will not help the Government to understand how to enhance quality of life. That is why a range of indicators needs to be developed and correlated over time with the subjective well-being question, so that trends can be established and policies changed accordingly.

There is already a large body of research into the determinants of happiness. A paper commissioned by DEFRA, “Review of research on the influences on personal well-being and application to policy making”, which was written by Professor Paul Dolan and others in 2006, gives a comprehensive review of the research that has been conducted so far. In particular, the findings on income and work are interesting. The paper states:

“The majority of individual level studies find a positive association between absolute income and well-being”.

We might assume that to be the case, given that most people tend to try hard to increase their income. However, the paper goes on to say:

“The results generally suggest that there are diminishing returns to income i.e. the well-being hit of income falls as income rises.”

Beyond a certain point, therefore, policies that prioritise making us richer will not necessarily yield large pay-offs in terms of our happiness.

The Treasury is right to identify employment as a key driver for quality of life, although that is not just about the growth as a result of higher employment, as might be thought. Instead, the same DEFRA paper found that

“being unemployed has severe and long lasting negative consequences for life satisfaction and happiness, which cannot be explained only in terms of the loss in income.”

The conclusion to be drawn from that is that even when someone who has been unemployed returns to work, they are unhappier than they were before, because the experience of being unemployed increases their feeling of insecurity even while they are in work. I know that, as a Labour Member, the Minister will welcome that finding, which suggests that there should be an even greater focus on ensuring that everyone has a genuine opportunity to work.

Regardless of the level of income, inequality negatively impacts on quality of life. People would rather earn £50,000 in a society where everyone else earns £25,000 than earn £100,000 in a society where everyone else earns £250,000. Therefore, the issue of income inequality is important, so it is especially worrying that according to the Institute for Fiscal Studies and the gini coefficient the gap between the rich and the poor has widened under this Government.

On income and work, it is also important to bear in mind the current personal debt crisis. The evidence shows that while secured debts, such as a mortgage, do not negatively impact on someone’s quality of life, large amounts of unsecured debt cause a great deal of worry and unhappiness.

Interestingly, the DEFRA paper also points out that, according to the research, commuting is:

“generally associated with lower levels of life satisfaction and mood.”

However, it is rare that Ministers make proud declarations about efforts to cut the average commute of the British citizen. The issue of commuting is not just about congestion; it is about adopting a different approach to how and where we work. Taken in hand with people saying that they want more time with friends and family, the case for moving to more flexible working practices is overwhelming. We need to tackle the culture of presenteeism and use technology to cut out unnecessary commutes, which would also have environmental benefits.

Research points to many other factors that have an impact on happiness. Health is a major one, especially and unsurprisingly as we get older. Locus of control is also a common influencer of life satisfaction; when people feel that decisions are made for them and that they have little influence over the events in their lives, they tend to be unhappier.

All that information should be shaping Government policy, which brings me to the action that the Treasury should take. An Ipsos Mori poll found that 85 per cent. of people in the UK agree that

“Policies should put less emphasis on consumption, and more emphasis on other aspects of the quality of life”.

In order to prioritise improving quality of life, it is essential to measure it and research what affects it, so the first and most obvious thing to do is to create an index of the nation’s happiness. The old adage that “what gets measured gets done” has a ring of truth about it here. No one bothered about GDP 100 years ago, because we did not have the tools to measure it; now it seems to be the obsession of most Governments around the world, although, as I have mentioned, that situation is changing.

A happiness index, including subjective well-being measures and a range of quality of life indicators, would complement GDP as a general measure of progress. It would provide a tangible way of monitoring the Treasury’s goal of creating a better quality of life, and it would help to identify the policy levers to enhance happiness in the future. Importantly, it would also provide greater clarity within Government; many Departments now refer to the concepts of “quality of life” or “well-being” in their mission statements, but there is no common measurement.

In developing such an index, the Government should stick to five key principles: the index should be well grounded in the science; it should be conducted at regular intervals; it should have a large sample size; it should be robust and proof against manipulation; and, ideally, it should be part of an international effort to enable comparisons across nations—hence my early-day motion calling for the Government to work closely with the French as the French develop their index.

Even before such an index is created, the Treasury could integrate existing happiness research into its work. The supporting evidence on well-being should be consulted in allocating resources, assessing new policies and deciding priorities. Much as the environmental or budgetary impact of a policy is looked at, the well-being impact should also be considered.

I came to listen to this debate to find out what it was about, to be honest, but I agree with everything that my hon. Friend has said. Does she agree that if we were to adopt the strategy that she has proposed, there would be a much stronger case for saving local post offices and other services that the Government perhaps do not see as financial priorities?

I agree with my hon. Friend. Post offices are a good example of a local service whose social impact and value to the community are not necessarily captured in financial measurements. He has made his point very well.

These proposals are not always about spending more money, the Minister will be glad to hear. Indeed, taking well-being into the equation may sometimes lead to ending practices and projects that cost money, or implementing policies that save money. A cross-departmental approach is crucial, as sometimes the spending will be in one Department and the saving in another. For example, the Layard proposals on mental health to train new cognitive behavioural therapists to help people with depression get back to work will result in savings on incapacity benefits. I am pleased that the Government have taken those ideas on board, but there are many other examples that we are missing out on because we do not measure quality of life in any regular, clear and robust way.

I hope that in her response the Minister will take my views on board and explain whether the Treasury is prepared to look at creating a well-being index for use across Government, and to co-ordinate efforts across Departments to use existing research to improve quality of life, as its mission statement commits it to do.

I congratulate the hon. Member for East Dunbartonshire (Jo Swinson) on securing this debate. I certainly hope that it made her happy. She discussed some issues of economic interest that, obviously, arose from ideas that occurred to her in her first economics lectures—I had similar ideas when I went to my first economics lectures—and some of the philosophical issues that underpin the assumptions that come together to give us our statistics.

Quality of life is obviously a wide issue, and many of the Treasury’s core functions improve people’s quality of life. As the hon. Lady said, increasing the wealth of individuals in the UK as a whole through gross domestic product is not the only determinant of quality of life, and I assure her that we do not hope and pray for natural disasters in order to see GDP levels rise. I suspect that we are as aware as she is of some of the perverse things that can happen if we apply the measurement of certain statistics with no sense about how we interpret them. It is always important to apply the common-sense test, let alone the happiness test, to the way that economics defines statistics and measures things.

Clearly, GDP does have a role. As we see in many countries without economic development, other factors which determine quality of life—schooling, health, cultural activities, security through policing and the rule of law, for example—are difficult to introduce, let alone safeguard and improve. GDP is a necessary but not sufficient condition for the higher levels of happiness that the hon. Lady aspires to for us all.

GDP is a measure of economic activity. It is generally accepted that it is not a perfect measure of wider welfare. To that extent, I certainly agree with the hon. Lady’s analysis. There is a wide body of work in the economics and statistical literature on alternative methods of measuring welfare. Such research has a long history, with early work in the area by Weisman and Stiglitz and, more recently, as she mentioned, by Richard Layard, who has been investigating the economics of happiness. That approach to assessing welfare combines economics with techniques more commonly used by psychologists.

Such research highlights factors other than income which affect well-being. The hon. Lady raised one in particular: the welfare effects of inequality. I well remember learning about bliss points when I was studying welfare economics. She may remember them, too. Obviously, finding society’s bliss point is what all Governments wish to do.

The research is interesting, and it provides useful insights. The economics of happiness literature does not purport to replace income-based measures of welfare, but instead complements them with broader measures of well-being. Other work by Metz, Riley and Weale at the National Institute of Economic and Social Research shows that between 1997 and 2002 the real GDP of both France and the UK grew at 2.7 per cent. per annum. However, real income, which they argue is a better measure of welfare, as it relates more directly to resources available for current and future consumption, grew at 3.2 per cent. per annum in the UK compared with just 2.5 per cent. in France. The Government continue to monitor developments in this area and to look at different ways of measuring even familiar concepts.

Another limitation of GDP as a welfare measure is that it includes paid work but not the unpaid work that we do—I say this as an avowed feminist—and an entire body of feminist literature, which I am always interested in keeping in touch with, demonstrates that. Cooking, cleaning, do-it-yourself, caring for dependants—none of that is measured.

Measuring and valuing unpaid output produced by households in the UK is an important body of research. In 2002, the Office for National Statistics published an experimental household satellite account which measured non-market production by households using the third-party criterion first developed by Margaret Reid in the 1930s; that is, that if someone else could be paid to provide the service, it should be measured. Its experimental estimate for 2000 showed that including such activity would almost double GDP. Clearly, that is an area in which I am extremely interested.

It is also important to note that the standard measure of GDP does not measure degradation of the environment or depreciation of natural resources. The hon. Lady touched on those issues in her wide-ranging remarks. Because it does not measure those things, we as policy makers and people who live on this planet increasingly have to take account of them. The ONS does, however, produce a set of UK environmental accounts that provide information about the environmental impact of economic activity, in particular about the emissions of pollutants, and about the importance of natural resources to the economy.

The hon. Lady is right to emphasise the narrowness of GDP. It is an important measure, but it is by no means the only one. However, using GDP as a measure of economic activity does have three advantages: it is a well-developed measure, it is easily understood, and it is compiled using a set of internationally agreed definitions.

Before I go into any more detail, I want to deal with a couple of points that the hon. Lady raised, particularly whether we should create an index of happiness. Such an index would be useful for policy making, and Her Majesty’s Treasury does follow research developments in this area, particularly the work of Richard Layard. However, GDP is still important and it is a better developed measure, but that does not mean that we rule out for all time the development of more sophisticated measurements.

The hon. Lady might want to engage with the now independent ONS, which would have to develop methodologies and have contacts internationally to be able to see whether work could be pushed forward on developing the wider measures of well-being and quality of life that she seeks.

I am enjoying the Minister’s comments and I welcome much of what she has said, but I would like to push her slightly further. She said that GDP is a better developed method of measurement, which is obvious, but rather than waiting for more sophisticated measures of happiness and well-being to appear suddenly on the scale, will the Treasury take a proactive role in helping to develop them, including internationally?

We are interested in a more sophisticated understanding of the effects of economic and other human activity. Including the 50 per cent. of people whose work is often not counted—the unpaid area of the economy is a case in point—sustainability, the pricing and use of finite resources, and other externalities such as pollution when we measure and account for what we do, is clearly important as we enter an era in which we must re-engineer our economies to ensure sustainable economic activity that does not do more damage than good to the planet. To understand, for example, how carbon footprints are affected by activity, we must measure the whole-life carbon costs of those activities.

The science and this area of economics is in need of rapid development, if I may put it that way. In the past, it has not been mainstream; in fact, it has been defined out of the mainstream, as have unpaid work, happiness and welfare economics. The hon. Lady is right to say that all the way through the development of classical economic theory, other strands of study have been pursued by welfare economists. For example, as she said, Nicolas Sarkozy has contacted the Nobel prize-winning economist Amartya Sen, who has done some extremely important work in that field, and I can assure the hon. Lady that the Treasury is well aware of such theoretical developments.

Clearly, we need to see what we can do to ensure that the insights given to us by different ways of measuring and interpreting human activity are incorporated into what we do. Does that mean that we will abandon the measurement of GDP? Of course not. Does it mean that we need quickly to develop internationally agreed methods of measuring the carbon costs of activity? Yes. Does it mean that we could begin to consider whether we can develop the capacity both nationally and internationally to produce what the hon. Lady referred to as a happiness index or some form of quality-of-life measurement that takes on board a wider range of considerations than narrow GDP? Yes. Are we close to developing such an index this instant? No, we are not, and nor are we in a position from which to go forth confidently into international statistical conferences and hope for agreement on such measurement.

It is important, especially when measuring the national account, to use definitions that are agreed internationally, which makes them useful for cross-country comparisons. There are many strands to the work that the hon. Lady described in this fascinating but all-too-brief debate. I do not want to slam the door in any way on the ideas that she has introduced, but a great deal of work needs to be done, nationally and internationally, to get agreement on standards before we can hope to proceed.

I thank the hon. Lady for pursuing these issues, which are important in widening our general understanding of how human economic activity impacts on the societies to which it relates and beyond, to the sustainability of the planet, fairness between genders and fairness between countries. I aspire, like her, to see in the 21st century the narrower view of economics succeeded by a more holistic view that enables us to go forward with analytical tools and measurements, so that we can more appropriately assess the effects of our society’s activity. That way, we could make policy decisions in a more sophisticated way than the current narrow economic measurements enable us to do.

The hon. Lady should not throw the baby out with the bath water. I am sure that she recognises that GDP and some of the pure economic ways of measuring things have their place in our society. After all, even neo-classical economics developed the concept of neo-classical endogenous growth theory, which is a clever way of saying that if people are happy at work, they tend to be more productive.

Question put and agreed to.

Adjourned accordingly at five minutes to Five o’clock.